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Organization
L-NEWCO
Active
Organization
L-NEWCO
Active
Other names
VITALITI
Organization subpart
No
Provider details
NPI number
Authorized official
AQIL SAFDAR (COO)
(401) 545-0716
Entity
Organization
Contact information
Practice address
370 CONVENTION WAY, REDWOOD CITY, CA 94063-1405
(401) 545-0716
Mailing address
370 CONVENTION WAY, REDWOOD CITY, CA 94063-1405
Taxonomy
Speciality
Code
Description
License number
State
202D00000X
Integrative Medicine Physician
—
—
207Q00000X
Family Medicine Physician
—
—
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Enumeration date
08/27/2024
Last updated
08/27/2024
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