Organization
NEW VITALITY CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GUSTAVO ADOLFO GROSS MD (OWNER)
(830) 491-2151
Entity
Organization
Contact information
Practice address
1207 N VIRGINIA ST, PORT LAVACA, TX 77979-2506
(361) 746-1588
(361) 400-5310
Mailing address
1207 N VIRGINIA ST, PORT LAVACA, TX 77979-2506
(361) 746-1588
(361) 400-5310
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00886
STATE LIC NUMBER
TX
Enumeration date
05/02/2014
Last updated
05/02/2014
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