Provider Demographics
NPI:1982859583
Name:VITALITY HEALTH GROUP INC
Entity Type:Organization
Organization Name:VITALITY HEALTH GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:H
Authorized Official - Last Name:DANIELS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-633-4177
Mailing Address - Street 1:6333 WOODMAN AVE
Mailing Address - Street 2:SUITE K
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91401-2361
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6333 WOODMAN AVE
Practice Address - Street 2:SUITE K
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91401-2361
Practice Address - Country:US
Practice Address - Phone:818-633-4177
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-24
Last Update Date:2008-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC30416207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty