SAN CLEMENTE VITALITY CENTER INC. (NPI# 1134773971) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1134773971 |
| Entity Type | Organization |
| Organization Name | SAN CLEMENTE VITALITY CENTER INC. |
| Practice Address |
647 Camino De Los Mares Ste 218 San Clemente CA 92673-2807 |
| Mailing Address |
15520 Rockfield Blvd #a200 Irvine CA 92618-6705 |
| Practice Telephone | 9494417755 |
| Practice Fax Number | 9495989990 |
| Mailing Telephone | 9495989999 |
| Mailing Fax Number | 9495989990 |
| Enumeration Date | 2019-07-30 |
| Last Update Date | 2019-07-30 |
| Authorized Official Name | BURTON WAGNER (OWNER/PROVIDER) |
| Authorized Official Telephone | 9494417755 |
| Authorized Official Credential | D.C. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 111N00000X | Chiropractor | Chiropractic Providers |
| Street Address |
647 CAMINO DE LOS MARES STE 218 |
| City | SAN CLEMENTE |
| State | CA |
| Zip Code | 92673-2807 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1659332880 | Michelle Renee Paul | Physical Therapy Assistant | 647 Camino De Los Mares, San Clemente, CA 92673-2825 | 2006-03-29 |
| 1154812436 | Veronique Emma Wagner | Chiropractor | 647 Camino De Los Mares, Suite 220, San Clemente, CA 92673-9267 | 2018-05-23 |
| 1881091023 | Richard Huggins | Specialist | 647 Camino De Los Mares, 221, San Clemente, CA 92673-2825 | 2014-12-03 |
| 1154643286 | Tma Pathology Services | Pathology | 647 Camino De Los Mares, 223, San Clemente, CA 92673-2825 | 2010-02-16 |
| 1477786291 | Thomas G Hirose, M.d. Apc Laboratory | Clinical Medical Laboratory | 647 Camino De Los Mares, Suite 223, San Clemente, CA 92673-2807 | 2009-08-27 |
| 1558597146 | Affiliated Psychiatric Medical Group | Psychologist | 647 Camino De Los Mares, #226, San Clemente, CA 92673-2807 | 2009-06-09 |
| 1013143825 | Tma Coagulation Specialists | Pathology | 647 Camino De Los Mares, Suite 223, San Clemente, CA 92673-2807 | 2009-06-08 |
| 1568698512 | California Molecular Reference Laboratories | Clinical Medical Laboratory | 647 Camino De Los Mares, Suite 225, San Clemente, CA 92673-2807 | 2009-06-04 |
| 1356594113 | Teresa Molina Barbanell | Physical Therapist | 647 Camino De Los Mares, San Clemente, CA 92673-2825 | 2008-10-24 |
| 1629240601 | Julie Yahui-chen Nelson | Acupuncturist | 647 Camino De Los Mares, Suite 221, San Clemente, CA 92673-2825 | 2008-03-30 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1497246474 | Cynthia Hull Warren | Nutritionist | 2027 Via Concha, San Clemente, CA 92673 | 2018-05-24 |
| 1063942688 | Trinh T Tran | Pharmacist | 638 Camino De Los Mares #d5, San Clemente, CA 92673 | 2017-06-15 |
| 1427421791 | Jessica A Currens | Nurse Practitioner | 1001 Avenida Pico Ste C517, San Clemente, CA 92673 | 2015-11-08 |
| 1184010647 | Garrett Bryon Rubio | Student in an Organized Health Care Education/Training Program | 905 Calle Amanecer Ste. 265, San Clemente, CA 92673 | 2015-04-11 |
| 1255733853 | Body Mind Spirit Iop Inc | Psychologist | 665 Camino De Los Mares Ste 104, San Clemente, CA 92673 | 2014-09-25 |
| 1548677438 | Jessica Ann Riley | Dermatology | 1300 Avenida Vista Hermosa Ste 150, San Clemente, CA 92673 | 2014-07-13 |
| 1427398718 | Veena Menda | Specialist | 2232 Calle Opalo, San Clemente, CA 92673 | 2013-02-22 |
| 1124383781 | Alexandra Rose Corporation | Substance Abuse Rehabilitation Facility | 4009 Calle Abril, San Clemente, CA 92673 | 2012-07-10 |
| 1457612574 | Noelle J Deckman | Psychologist | 629 Camino De Los Mares Ste 207a, San Clemente, CA 92673 | 2012-06-05 |
| 1851686471 | Meighan Bartholomew Merono | Pharmacist | 990 Avenida Vista Hermosa, San Clemente, CA 92673 | 2011-06-10 |
| Find all providers in zip 92673 | ||||
| Taxonomy Code | 111N00000X |
| Grouping | Chiropractic Providers |
| Classification | Chiropractor |
| A provider qualified by a Doctor of Chiropractic (D.C.), licensed by the State and who practices chiropractic medicine -that discipline within the healing arts which deals with the nervous system and its relationship to the spinal column and its interrelationship with other body systems. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1275161374 | Strive Chiropractic and Integrative Health, Gill Corporation | Chiropractor | 16 Calle Loyola, San Clemente, CA 92673-7058 | 2020-04-01 |
| 1528692183 | Connor James Naasz | Chiropractor | 113 W Avenida Valencia, San Clemente, CA 92672-4241 | 2020-02-23 |
| 1174089932 | Corey Diamond | Chiropractor | 629 Camino De Los Mares Ste 104, San Clemente, CA 92673-2829 | 2019-02-18 |
| 1144786385 | Mike Jack Laubach | Chiropractor | 903 Buena Vis Apt E, San Clemente, CA 92672-5068 | 2019-02-12 |
| 1801398466 | Stephanie Chen | Chiropractor | 1502 N El Camino Real Ste 103, San Clemente, CA 92672-5906 | 2018-02-28 |
| 1346652666 | Tyson Synergy1 Solutions, Inc. | Chiropractor | 161 Avenida Baja, San Clemente, CA 92672-2465 | 2014-05-21 |
| 1245659507 | Burton Wagner | Chiropractor | 647 Camino De Los Mares Ste 220, San Clemente, CA 92673-2807 | 2014-04-15 |
| 1295175024 | Ryan Roger Anderson | Chiropractor | 653 Camino De Los Mares Ste 100, San Clemente, CA 92673-2808 | 2013-06-25 |
| 1780923268 | Stephen Herbert Zoerner | Chiropractor | 2116 Via Aguila, San Clemente, CA 92673-5654 | 2013-02-04 |
| 1588968846 | Erin Iselin Christiansen | Chiropractor | 903 Calle Amanecer Ste 230, San Clemente, CA 92673-6251 | 2010-12-30 |
| Find all providers in SAN CLEMENTE | ||||
| City | SAN CLEMENTE |
| Zip Code | 92673 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.