Provider Demographics
NPI:1649052218
Name:VITALITY URGENT CARE A MEDICAL CORPORATION
Entity type:Organization
Organization Name:VITALITY URGENT CARE A MEDICAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING REPRESENTATIVE
Authorized Official - Prefix:
Authorized Official - First Name:TANIUSCA
Authorized Official - Middle Name:S
Authorized Official - Last Name:LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-821-3252
Mailing Address - Street 1:29738 RANCHO CALIFORNIA RD STE B
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92591-5322
Mailing Address - Country:US
Mailing Address - Phone:951-303-6440
Mailing Address - Fax:951-303-6449
Practice Address - Street 1:29738 RANCHO CALIFORNIA RD STE B
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92591-5322
Practice Address - Country:US
Practice Address - Phone:951-303-6440
Practice Address - Fax:951-303-6449
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-18
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care