| 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 |