| New Vitality Clinic | |
|
1207 N Virginia St Port Lavaca TX 77979-2506 | |
| (361) 746-1588 | |
| (361) 400-5310 |
| Full Name | New Vitality Clinic |
|---|---|
| Speciality | Clinic/center |
| Location | 1207 N Virginia St, Port Lavaca, Texas |
| Authorized Official Name and Position | Gustavo Adolfo Gross (OWNER) |
| Authorized Official Contact | 8304912151 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| New Vitality Clinic 1207 N Virginia St Port Lavaca TX 77979-2506 Ph: (361) 746-1588 | New Vitality Clinic 1207 N Virginia St Port Lavaca TX 77979-2506 Ph: (361) 746-1588 |
| NPI Number | 1285044057 |
|---|---|
| Provider Enumeration Date | 05/02/2014 |
| Last Update Date | 05/02/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1285044057 | NPI | - | NPPES |
| 00886 | Other | TX | STATE LIC NUMBER |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (Texas) | Primary |
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