Individual
KENNETH CRAIG VITALE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
350 DICKINSON ST, SUITE 121, SAN DIEGO, CA 92103-1913
(619) 543-2539
(619) 543-2540
Mailing address
350 DICKINSON ST, SUITE 121, SAN DIEGO, CA 92103-1913
(619) 543-2539
(619) 543-2540
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
C132964
CA
2081S0010X
Sports Medicine (Physical Medicine & Rehabilitation) Physician
C132964
CA
Other
Enumeration date
10/04/2005
Last updated
01/17/2015
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