Provider Demographics
NPI:1740084235
Name:VITAGEN MEDICAL CORPORATION
Entity type:Organization
Organization Name:VITAGEN MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ANAND
Authorized Official - Middle Name:
Authorized Official - Last Name:MUTHIAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-292-4094
Mailing Address - Street 1:1039 STONY BROOK CT
Mailing Address - Street 2:
Mailing Address - City:CLAREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:91711-1834
Mailing Address - Country:US
Mailing Address - Phone:818-292-4094
Mailing Address - Fax:
Practice Address - Street 1:1340 E ROUTE 66 STE 106
Practice Address - Street 2:
Practice Address - City:GLENDORA
Practice Address - State:CA
Practice Address - Zip Code:91740-3783
Practice Address - Country:US
Practice Address - Phone:818-292-4094
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-03
Last Update Date:2025-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No2084A0401XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction MedicineGroup - Multi-Specialty
No2084P0802XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction PsychiatryGroup - Multi-Specialty