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Organization
VITUITY - PRIMARY CARE GLENDALE PC
Active
Organization
VITUITY - PRIMARY CARE GLENDALE PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
THEOPHILE G. KOURY (PRESIDENT)
(510) 350-2638
Entity
Organization
Contact information
Practice address
1560 E CHEVY CHASE DR STE 355, GLENDALE, CA 91206-4159
(747) 212-3441
Mailing address
2100 POWELL ST STE 400, EMERYVILLE, CA 94608-1826
(510) 350-2638
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
—
—
207Q00000X
Family Medicine Physician
Primary
—
—
207QG0300X
Geriatric Medicine (Family Medicine) Physician
—
—
207QH0002X
Hospice and Palliative Medicine (Family Medicine) Physician
—
—
207R00000X
Internal Medicine Physician
—
—
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
—
—
207RH0002X
Hospice and Palliative Medicine (Internal Medicine) Physician
—
—
207V00000X
Obstetrics & Gynecology Physician
—
—
208000000X
Pediatrics Physician
—
—
2080N0001X
Neonatal-Perinatal Medicine Physician
—
—
208D00000X
General Practice Physician
—
—
Other
Enumeration date
09/23/2020
Last updated
06/16/2021
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