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Organization
HEALTH AND VITALITY CENTER MEDICAL CORPORATION
Active
Organization
HEALTH AND VITALITY CENTER MEDICAL CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHIVA LALEZAR D.O. (PRESIDENT)
(310) 477-1166
Entity
Organization
Contact information
Practice address
11600 WILSHIRE BLVD, SUITE 120, LOS ANGELES, CA 90025-5781
(310) 477-1166
(310) 477-9911
Mailing address
11600 WILSHIRE BLVD, SUITE 120, LOS ANGELES, CA 90025-5781
(310) 477-1166
(310) 477-9911
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
20A8026
CA
Other
Enumeration date
06/05/2009
Last updated
06/05/2009
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