Provider Demographics
NPI:1932989241
Name:VITALCARE LABS, LLC
Entity type:Organization
Organization Name:VITALCARE LABS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LORRAINE
Authorized Official - Middle Name:ZVICHAPERA
Authorized Official - Last Name:MUTSVUNGUMA
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:626-418-2594
Mailing Address - Street 1:17585 STATE HIGHWAY 19 STE 100
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:TX
Mailing Address - Zip Code:75103-5794
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:17585 STATE HIGHWAY 19 STE 300
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:TX
Practice Address - Zip Code:75103-5796
Practice Address - Country:US
Practice Address - Phone:626-418-2594
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-03
Last Update Date:2025-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory