Organization Name: | VITAL THERAPEUTICS INC. |
NPI Number: | 1346634318 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | AIRENE CATAPAT (PRESIDENT) |
Mailing Address: | 536 W Daybreak Ln Round Lake |
State: | IL US |
Postal Code: | 600735696 |
Phone Number: | 2247890837 |
Fax Number: | |
NPI Enumeration Date: | 03/26/2015 |
NPI Last Update Date: | 03/26/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QP2000X |
License Number: | 070016796 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IL |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Physical Therapy |
Taxonomy Definition: |