# VITALIS WELLNESS CENTER OF PHOENIX, AZ PC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Vitalis Wellness Center, AZ PC
- **Organization subpart:** No

## Provider details

- **NPI number:** 1497421101
- **Authorized official:** NELLIE IDARA SAMUEL DNP (CO-OWNER)
- **Authorized official phone:** (800) 922-1873

## Contact information

- **Practice address:** 1910 S STAPLEY DR STE 120, MESA, AZ 85204-6676
- **Practice address phone:** (800) 922-1873
- **Mailing address:** 1910 S STAPLEY DR STE 120, MESA, AZ 85204-6676
- **Mailing address phone:** (800) 922-1873

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 2084P0301X | Brain Injury Medicine (Psychiatry & Neurology) Physician | — | NULL | Yes |
| 2084P0301X | Brain Injury Medicine (Psychiatry & Neurology) Physician | — | — | Yes |
| 2084P0800X | Psychiatry Physician | — | NULL | — |
| 2084P0800X | Psychiatry Physician | — | — | — |
| 2084P0804X | Child & Adolescent Psychiatry Physician | — | NULL | — |
| 2084P0804X | Child & Adolescent Psychiatry Physician | — | — | — |

## Other

- **Enumeration date:** 08/22/2021
- **Last updated:** 07/19/2024