1992077192 NPI number — VITAL HEALTH INSTITUTE

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992077192 NPI number — VITAL HEALTH INSTITUTE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VITAL HEALTH INSTITUTE
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1992077192
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/04/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
14830 LOS GATOS BLVD
Provider Second Line Business Mailing Address:
SUITE 300
Provider Business Mailing Address City Name:
LOS GATOS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95032-2083
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
408-358-2511
Provider Business Mailing Address Fax Number:
408-358-1009

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
15055 LOS GATOS BLVD
Provider Second Line Business Practice Location Address:
SUITE 250
Provider Business Practice Location Address City Name:
LOS GATOS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95032-2083
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
408-358-2511
Provider Business Practice Location Address Fax Number:
408-358-1009
Provider Enumeration Date:
02/02/2012

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
COOK
Authorized Official First Name:
ANDREW
Authorized Official Middle Name:
SCOTT
Authorized Official Title or Position:
FOUNDER AND MEDICAL DIRECTOR
Authorized Official Telephone Number:
408-358-2511

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  A49312 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)