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Organization
VITA LUXE, LLC
Active
Organization
VITA LUXE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JEREMY POULSEN DO (MANAGING MEMBER)
(559) 313-6472
Entity
Organization
Contact information
Practice address
6322 S 3000 E STE 170, SALT LAKE CITY, UT 84121-7290
(801) 513-3223
Mailing address
6322 S 3000 E STE 170, SALT LAKE CITY, UT 84121-7290
(801) 513-3223
Taxonomy
Speciality
Code
Description
License number
State
207YS0123X
Facial Plastic Surgery Physician
Primary
—
NULL
207YS0123X
Facial Plastic Surgery Physician
Primary
—
—
Other
Enumeration date
09/24/2026
Last updated
09/24/2026
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