# VITABOOST WELLNESS CENTER

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- **Entity:** Organization
- **Status:** Active
- **Other names:** VITALITY BOOST WELLNESS
- **Organization subpart:** No

## Provider details

- **NPI number:** 1518627033
- **Authorized official:** DR. AUDRA ELAINE FORD MD (MEDICAL DIRECTOR)
- **Authorized official phone:** (310) 877-8067

## Contact information

- **Practice address:** 20955 DEVONSHIRE ST, CHATSWORTH, CA 91311-2313
- **Practice address phone:** (310) 877-8067
- **Practice address fax:** (818) 280-3874
- **Mailing address:** 20955 DEVONSHIRE ST, CHATSWORTH, CA 91311-2313
- **Mailing address phone:** (310) 877-8067
- **Mailing address fax:** (818) 280-3874

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 302R00000X | Health Maintenance Organization | — | NULL | Yes |

## Other

- **Enumeration date:** 12/23/2021
- **Last updated:** 12/23/2021