Provider Demographics
NPI:1104628676
Name:VITALIA HOLISTICS CORP
Entity type:Organization
Organization Name:VITALIA HOLISTICS CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND TREASURER
Authorized Official - Prefix:DR
Authorized Official - First Name:CLARA
Authorized Official - Middle Name:SOFIA
Authorized Official - Last Name:SANTIAGO ROSADO
Authorized Official - Suffix:
Authorized Official - Credentials:ND
Authorized Official - Phone:939-229-2222
Mailing Address - Street 1:G 38 CALLE BATEY REPARTO CAGUAX
Mailing Address - Street 2:
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00725
Mailing Address - Country:US
Mailing Address - Phone:939-229-2222
Mailing Address - Fax:
Practice Address - Street 1:1 CALLE SAN ANTONIO N
Practice Address - Street 2:
Practice Address - City:GUAYAMA
Practice Address - State:PR
Practice Address - Zip Code:00784-4719
Practice Address - Country:US
Practice Address - Phone:939-229-2222
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-26
Last Update Date:2025-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service