# VITALITY MEDICAL CENTER INC

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

## Provider details

- **NPI number:** 1184198442
- **Authorized official:** LILIA SEROBIAN (SECRETARY)
- **Authorized official phone:** (818) 805-0005

## Contact information

- **Practice address:** 1648 W GLENOAKS BLVD \# 101, GLENDALE, CA 91201-1827
- **Practice address phone:** (818) 805-0005
- **Practice address fax:** (818) 805-0050
- **Mailing address:** 1648 W GLENOAKS BLVD \# 101, GLENDALE, CA 91201-1827
- **Mailing address phone:** (818) 805-0005
- **Mailing address fax:** (818) 805-0050

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207P00000X | Emergency Medicine Physician | — | NULL | — |
| 207P00000X | Emergency Medicine Physician | — | — | — |
| 208D00000X | General Practice Physician | — | NULL | Yes |
| 208D00000X | General Practice Physician | — | — | Yes |
| 363L00000X | Nurse Practitioner | — | NULL | — |
| 363L00000X | Nurse Practitioner | — | — | — |

## Other

- **Enumeration date:** 01/18/2019
- **Last updated:** 01/18/2019

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | C4208588 | CORPORATION NUMBER | CA |