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Organization
VITABOOST WELLNESS CENTER
Active
Organization
VITABOOST WELLNESS CENTER
Active
Other names
VITALITY BOOST WELLNESS
Organization subpart
No
Provider details
NPI number
Authorized official
DR. AUDRA ELAINE FORD MD (MEDICAL DIRECTOR)
(310) 877-8067
Entity
Organization
Contact information
Practice address
20955 DEVONSHIRE ST, CHATSWORTH, CA 91311-2313
(310) 877-8067
(818) 280-3874
Mailing address
20955 DEVONSHIRE ST, CHATSWORTH, CA 91311-2313
(310) 877-8067
(818) 280-3874
Taxonomy
Speciality
Code
Description
License number
State
302R00000X
Health Maintenance Organization
Primary
—
NULL
Other
Enumeration date
12/23/2021
Last updated
12/23/2021
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