Organization
VITALANT
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BHAVI A SHAH (CHIEF LEGAL & RISK OFFICER)
(480) 675-5653
Entity
Organization
Contact information
Practice address
10536 PETER A MCCUEN BLVD, MATHER, CA 95655-4128
(916) 456-1500
(916) 366-0791
Mailing address
10536 PETER A MCCUEN BLVD, MATHER, CA 95655-4128
(916) 456-1500
(916) 366-0791
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
05D0615608
CA
331L00000X
Blood Bank
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
ZZZ74771Z
—
CA
Enumeration date
04/24/2007
Last updated
10/08/2025
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