Provider Demographics
NPI:1770886335
Name:KARLA N. VITAL M.D.P.A.
Entity type:Organization
Organization Name:KARLA N. VITAL M.D.P.A.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KARLA
Authorized Official - Middle Name:NADINE
Authorized Official - Last Name:VITAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-538-1240
Mailing Address - Street 1:11920 ASTORIA BLVD
Mailing Address - Street 2:SUITE 370
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77089-6097
Mailing Address - Country:US
Mailing Address - Phone:713-538-1240
Mailing Address - Fax:713-538-1244
Practice Address - Street 1:11920 ASTORIA BLVD
Practice Address - Street 2:SUITE 370
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77089-6097
Practice Address - Country:US
Practice Address - Phone:713-538-1240
Practice Address - Fax:713-538-1244
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-20
Last Update Date:2011-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM2178174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXB127608Medicare PIN