Vitalis Wellness Center of Phoenix, Az PC

Primary specialty

Brain Injury Medicine (Psychiatry & Neurology) PhysicianTaxonomy code 2084P0301X

Legal business name

VITALIS WELLNESS CENTER OF PHOENIX, AZ PC

Doing business as

Vitalis Wellness Center, AZ PC

Practice address

1910 S Stapley Dr Ste 120
Mesa, AZ 85204-6676

Phone

(800) 922-1873

NPI assigned

Aug 22, 2021

Last updated

Jul 19, 2024By 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

Nellie Idara Samuel, DNP

Title

Co-Owner

Phone

(800) 922-1873

Specialties & licenses 3

Addresses

Other names 1

• Vitalis Wellness Center, AZ PC Doing business as

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Samuel I Samuel, MD

  • Psychiatry Physician
  • Salinas, CA
  • NPI 1992833099

  Brain Injury Medicine

  NPD

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

{
    "created_epoch": "1629590400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1721347200000",
    "number": "1497421101",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1910 S STAPLEY DR STE 120",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852046676",
            "telephone_number": "800-922-1873"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1910 S STAPLEY DR STE 120",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852046676",
            "telephone_number": "800-922-1873"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VITALIS WELLNESS CENTER OF PHOENIX, AZ PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-08-22",
        "last_updated": "2024-07-19",
        "certification_date": "2024-07-16",
        "status": "A",
        "authorized_official_last_name": "SAMUEL",
        "authorized_official_first_name": "NELLIE",
        "authorized_official_middle_name": "IDARA",
        "authorized_official_title_or_position": "CO-OWNER",
        "authorized_official_telephone_number": "800-922-1873",
        "authorized_official_credential": "DNP"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0804X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0301X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Brain Injury Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Vitalis Wellness Center, AZ PC",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Vitalis Wellness Center, AZ PC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Vital Turn LLC
• Manuela Vital, A-NP
• Stephen Joseph Vital, D.M.D.
• Vital4Men, PLLC
• Vitalis Family Health PLLC
• Vitality Med Spa
• Vitality Medspa, LLC.
• Armando Viterk
• Vito Anesthesia LLC
• Kanti Sri Vittala, MD

• Brain Injury Medicine (Psychiatry & Neurology) Physician in Mesa, AZ
• Providers in Mesa, AZ by specialty
• Brain Injury Medicine (Psychiatry & Neurology) Physician in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 19, 2024; 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.