Vita Luxe, LLC

Primary specialty

Facial Plastic Surgery PhysicianTaxonomy code 207YS0123X

Legal business name

VITA LUXE, LLC

Practice address

6322 S 3000 E Ste 170
Salt Lake City, UT 84121-7290

Phone

(801) 513-3223

NPI assigned

Sep 24, 2026

Last updated

Sep 24, 2026By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Jeremy Poulsen, DO

Title

Managing Member

Phone

(559) 313-6472

Specialties & licenses 1

Addresses

Tax ID family

Vita Luxe LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Vita Luxe, LLC

  • Medical Specialty Clinic/Center
  • Salt Lake City, UT
  • NPI 1053225953
  NPD tax ID

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1790208000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1790208000000",
    "number": "1093628786",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6322 S 3000 E STE 170",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841217290",
            "telephone_number": "801-513-3223"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6322 S 3000 E STE 170",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841217290",
            "telephone_number": "801-513-3223"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VITA LUXE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2026-09-24",
        "last_updated": "2026-09-24",
        "certification_date": "2026-09-24",
        "status": "A",
        "authorized_official_last_name": "POULSEN",
        "authorized_official_first_name": "JEREMY",
        "authorized_official_title_or_position": "MANAGING MEMBER",
        "authorized_official_telephone_number": "559-313-6472",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "207YS0123X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Otolaryngology, Facial Plastic Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Eric Michael Visser, DMD
• Jesse Nichole Visser, RN
• Vista Counseling Services, LLC
• Vistas Care Inc
• Vita Luxe, LLC
• Melissa Vitale, MD
• Vitality Medical Inc.
• Dagmar Vitek, M.D., M.P.H.
• John S Vitkus, PHD
• Janet Vivian, C.S.W.

• Facial Plastic Surgery Physician in Salt Lake City, UT
• Providers in Salt Lake City, UT by specialty
• Facial Plastic Surgery Physician in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 24, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.