Provider Demographics
NPI:1487087227
Name:VITALITY MEDICAL GROUP PC
Entity type:Organization
Organization Name:VITALITY MEDICAL GROUP PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:FOUNDER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:T
Authorized Official - Last Name:BELL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:951-389-0500
Mailing Address - Street 1:27699 JEFFERSON AVE STE 210
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92590-2696
Mailing Address - Country:US
Mailing Address - Phone:951-389-0500
Mailing Address - Fax:951-389-0528
Practice Address - Street 1:27699 JEFFERSON AVE STE 210
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92590-2696
Practice Address - Country:US
Practice Address - Phone:951-389-0500
Practice Address - Fax:951-389-0528
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-15
Last Update Date:2023-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty