Provider Demographics
NPI:1487950341
Name:VITA, LUIS F (CRT)
Entity type:Individual
Prefix:
First Name:LUIS
Middle Name:F
Last Name:VITA
Suffix:
Gender:M
Credentials:CRT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1542 E 218TH ST
Mailing Address - Street 2:
Mailing Address - City:CARSON
Mailing Address - State:CA
Mailing Address - Zip Code:90745-2441
Mailing Address - Country:US
Mailing Address - Phone:310-830-7090
Mailing Address - Fax:
Practice Address - Street 1:1 CIVIC PLAZA DR
Practice Address - Street 2:625
Practice Address - City:CARSON
Practice Address - State:CA
Practice Address - Zip Code:90745-2243
Practice Address - Country:US
Practice Address - Phone:310-549-4500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-09
Last Update Date:2011-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA30302227800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes227800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Certified