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Organization
NEURAL VITA THERAPEUTICS
Active
Organization
NEURAL VITA THERAPEUTICS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JESSE JAMES FOWLER (COO)
(516) 395-2167
Entity
Organization
Contact information
Practice address
1804 BACON ST, SAN DIEGO, CA 92107-3004
(516) 395-2167
Mailing address
1804 BACON ST, SAN DIEGO, CA 92107-3004
(516) 395-2167
Taxonomy
Speciality
Code
Description
License number
State
174200000X
Meals Provider
—
NULL
251B00000X
Case Management Agency
—
NULL
251E00000X
Home Health Agency
—
NULL
251F00000X
Home Infusion Agency
—
NULL
251K00000X
Public Health or Welfare Agency
—
NULL
251S00000X
Community/Behavioral Health Agency
—
NULL
251V00000X
Voluntary or Charitable Agency
—
NULL
252Y00000X
Early Intervention Provider Agency
—
NULL
261QM1102X
Military Outpatient Operational (Transportable) Component Clinic/Center
—
NULL
261QP2000X
Physical Therapy Clinic/Center
—
NULL
261QR1100X
Research Clinic/Center
—
NULL
332U00000X
Home Delivered Meals
—
NULL
335V00000X
Portable X-ray and/or Other Portable Diagnostic Imaging Supplier
Primary
—
NULL
343900000X
Non-emergency Medical Transport (VAN)
—
NULL
Other
Enumeration date
04/21/2026
Last updated
04/21/2026
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