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Organization

VITAL MEDICAL GROUP, INC

Active
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Organization

VITAL MEDICAL GROUP, INC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MR. MAXWELL JEN MD (MEDICAL DIRECTOR)
(818) 396-5158
Entity
Organization

Contact information

Practice address
1314 W GLENOAKS BLVD STE 205, GLENDALE, CA 91201-4890
(818) 396-5158
(818) 396-5073
Mailing address
1314 W GLENOAKS BLVD STE 205, GLENDALE, CA 91201-4890
(818) 396-5158
(818) 396-5073

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—

Other

Enumeration date
03/11/2024
Last updated
04/22/2024
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