# VITALITY SPARK LLC

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

## Provider details

- **NPI number:** 1235992652
- **Authorized official:** ANI PETROSYAN (CEO)
- **Authorized official phone:** (213) 474-7306

## Contact information

- **Practice address:** 1402 N MARIPOSA AVE APT 8, LOS ANGELES, CA 90027-5836
- **Practice address phone:** (213) 474-7306
- **Mailing address:** 1402 N MARIPOSA AVE APT 8, LOS ANGELES, CA 90027-5836
- **Mailing address phone:** (213) 474-7306

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332B00000X | Durable Medical Equipment & Medical Supplies | — | NULL | Yes |

## Other

- **Enumeration date:** 01/31/2024
- **Last updated:** 01/31/2024