# VITA LUXE, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1093628786
- **Authorized official:** DR. JEREMY POULSEN DO (MANAGING MEMBER)
- **Authorized official phone:** (559) 313-6472

## Contact information

- **Practice address:** 6322 S 3000 E STE 170, SALT LAKE CITY, UT 84121-7290
- **Practice address phone:** (801) 513-3223
- **Mailing address:** 6322 S 3000 E STE 170, SALT LAKE CITY, UT 84121-7290
- **Mailing address phone:** (801) 513-3223

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207YS0123X | Facial Plastic Surgery Physician | — | NULL | Yes |
| 207YS0123X | Facial Plastic Surgery Physician | — | — | Yes |

## Other

- **Enumeration date:** 09/24/2026
- **Last updated:** 09/24/2026