Provider Demographics
NPI:1659172138
Name:VITAL MEDICAL CORPORATION
Entity type:Organization
Organization Name:VITAL MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JENELYN
Authorized Official - Middle Name:
Authorized Official - Last Name:ALMONTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:840-237-2700
Mailing Address - Street 1:225 W HOSPITALITY LN STE 308
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92408-3221
Mailing Address - Country:US
Mailing Address - Phone:840-237-2700
Mailing Address - Fax:840-237-2727
Practice Address - Street 1:225 W HOSPITALITY LN STE 308
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92408-3221
Practice Address - Country:US
Practice Address - Phone:840-237-2700
Practice Address - Fax:840-237-2727
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-21
Last Update Date:2025-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty