Organization
VITABOOST WELLNESS CENTER
Active
Other names
VITALITY BOOST WELLNESS
Organization subpart
No
Provider details
NPI number
Authorized official
DR. AUDRA ELAINE FORD MD (MEDICAL DIRECTOR)
(310) 877-8067
Entity
Organization
Contact information
Practice address
20955 DEVONSHIRE ST, CHATSWORTH, CA 91311-2313
(310) 877-8067
(818) 280-3874
Mailing address
20955 DEVONSHIRE ST, CHATSWORTH, CA 91311-2313
(310) 877-8067
(818) 280-3874
Taxonomy
Speciality
Code
Description
License number
State
302R00000X
Health Maintenance Organization
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
553460
MEDICAL BOARD OF CALIFORNIA
CA
Enumeration date
12/23/2021
Last updated
12/23/2021
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