Provider Demographics
NPI:1316277171
Name:VITALE
Entity type:Organization
Organization Name:VITALE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:WOZNIAK
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:310-795-5854
Mailing Address - Street 1:1118 11TH ST
Mailing Address - Street 2:STE. 6
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90403-5318
Mailing Address - Country:US
Mailing Address - Phone:310-795-5854
Mailing Address - Fax:323-766-1103
Practice Address - Street 1:1118 11TH ST
Practice Address - Street 2:STE. 6
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90403-5318
Practice Address - Country:US
Practice Address - Phone:310-795-5854
Practice Address - Fax:323-766-1103
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-30
Last Update Date:2009-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN680091385H00000X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty
No385H00000XRespite Care FacilityRespite CareGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA002449639-0001-1OtherBUSINESS LICENSE