NPI | 1518627033 |
---|---|
Doing Business As | VITALITY BOOST WELLNESS |
Entity Type | Organization |
Authorized Contact | AUDRA ELAINE FORD Medical Director 310-877-8067 |
Organization Subpart ? | No |
Primary Taxonomy | 302R00000X Health Maintenance Organization |
Enumeration Date | 2021-12-23 |
Last Update Date | 2021-12-23 |