| NPI | 1427834431 |
|---|---|
| Former Legal Business Name | CORAL VITALITY LLC |
| Entity Type | Organization |
| Authorized Contact | STEPHANIE MANGUAL Pmhnp 915-221-5595 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry |
| Enumeration Date | 2023-09-05 |
| Last Update Date | 2023-09-05 |