Organization
VITALIS WELLNESS CENTER OF PHOENIX, AZ PC
Active
Other names
Vitalis Wellness Center, AZ PC
Organization subpart
No
Provider details
NPI number
Authorized official
NELLIE IDARA SAMUEL DNP (CO-OWNER)
(800) 922-1873
Entity
Organization
Contact information
Practice address
1910 S STAPLEY DR STE 120, MESA, AZ 85204-6676
(800) 922-1873
Mailing address
1910 S STAPLEY DR STE 120, MESA, AZ 85204-6676
(800) 922-1873
Taxonomy
Speciality
Code
Description
License number
State
2084P0301X
Brain Injury Medicine (Psychiatry & Neurology) Physician
Primary
—
—
2084P0800X
Psychiatry Physician
—
—
2084P0804X
Child & Adolescent Psychiatry Physician
—
—
Other
Enumeration date
08/22/2021
Last updated
07/19/2024
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