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Organization
AVITALITY MEDICAL PROFESSIONAL CORPORATION
Active
Organization
AVITALITY MEDICAL PROFESSIONAL CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LAN LAM PAC (OWNER)
(909) 395-9888
Entity
Organization
Contact information
Practice address
653 E E ST STE 109, ONTARIO, CA 91764-4257
(909) 395-9888
Mailing address
653 E E ST STE 109, ONTARIO, CA 91764-4257
(909) 395-9888
Taxonomy
Speciality
Code
Description
License number
State
173000000X
Legal Medicine
Primary
—
—
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Enumeration date
09/01/2026
Last updated
09/13/2026
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