Provider Demographics
NPI:1780342394
Name:VITAL AESTHETICS AND MEDICAL CENTRE INC
Entity type:Organization
Organization Name:VITAL AESTHETICS AND MEDICAL CENTRE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT /CEO
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:C
Authorized Official - Last Name:KEECH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:424-352-0326
Mailing Address - Street 1:1403 LOMITA BLVD STE 307
Mailing Address - Street 2:
Mailing Address - City:HARBOR CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90710-2085
Mailing Address - Country:US
Mailing Address - Phone:424-352-0326
Mailing Address - Fax:
Practice Address - Street 1:1403 LOMITA BLVD STE 307
Practice Address - Street 2:
Practice Address - City:HARBOR CITY
Practice Address - State:CA
Practice Address - Zip Code:90710-2085
Practice Address - Country:US
Practice Address - Phone:424-352-0326
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-01
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No163WG0000XNursing Service ProvidersRegistered NurseGeneral PracticeGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty