Provider Demographics
NPI:1992439400
Name:VITASANA OF SAN DIEGO LLC
Entity type:Organization
Organization Name:VITASANA OF SAN DIEGO LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER, PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:
Authorized Official - Last Name:BUDRAITIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-462-2273
Mailing Address - Street 1:7317 EL CAJON BLVD STE 204A
Mailing Address - Street 2:
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91942-7434
Mailing Address - Country:US
Mailing Address - Phone:619-462-2273
Mailing Address - Fax:619-342-7024
Practice Address - Street 1:7317 EL CAJON BLVD STE 204A
Practice Address - Street 2:
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942-7434
Practice Address - Country:US
Practice Address - Phone:619-462-2273
Practice Address - Fax:619-342-7024
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-11
Last Update Date:2022-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes253Z00000XAgenciesIn Home Supportive Care
No251B00000XAgenciesCase Management
No385H00000XRespite Care FacilityRespite CareGroup - Single Specialty