# NEURAL VITA THERAPEUTICS

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

## Provider details

- **NPI number:** 1134064652
- **Authorized official:** MR. JESSE JAMES FOWLER (COO)
- **Authorized official phone:** (516) 395-2167

## Contact information

- **Practice address:** 1804 BACON ST, SAN DIEGO, CA 92107-3004
- **Practice address phone:** (516) 395-2167
- **Mailing address:** 1804 BACON ST, SAN DIEGO, CA 92107-3004
- **Mailing address phone:** (516) 395-2167

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 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 | — | NULL | Yes |
| 343900000X | Non-emergency Medical Transport (VAN) | — | NULL | — |

## Other

- **Enumeration date:** 04/21/2026
- **Last updated:** 04/21/2026