Provider Demographics
NPI:1548422439
Name:VITAL HEALTH LLP
Entity type:Organization
Organization Name:VITAL HEALTH LLP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:R
Authorized Official - Last Name:VILLALTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:210-742-7300
Mailing Address - Street 1:PO BOX 1632
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78573-0029
Mailing Address - Country:US
Mailing Address - Phone:956-584-3231
Mailing Address - Fax:
Practice Address - Street 1:32685 US HIGHWAY 281 N STE 120
Practice Address - Street 2:
Practice Address - City:BULVERDE
Practice Address - State:TX
Practice Address - Zip Code:78163-3272
Practice Address - Country:US
Practice Address - Phone:210-742-7300
Practice Address - Fax:210-742-7301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-01
Last Update Date:2019-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX151603101Medicaid
TX151603101Medicaid