# MEN'S VITALITY & PERFORMANCE

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1780982561
- **Authorized official:** JOHN RISI (OWNER)
- **Authorized official phone:** (602) 314-5119

## Contact information

- **Practice address:** 4626 E SHEA BLVD, SUITE C230, PHOENIX, AZ 85028-3071
- **Practice address phone:** (602) 314-5119
- **Practice address fax:** (602) 368-4071
- **Mailing address:** 4626 E SHEA BLVD, SUITE 230, PHOENIX, AZ 85028-3071
- **Mailing address phone:** (602) 314-5119
- **Mailing address fax:** (602) 368-4071

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | 2830 | AZ | Yes |

## Other

- **Enumeration date:** 03/03/2011
- **Last updated:** 03/03/2011