NEURAL VITA THERAPEUTICS NPI 1134064652

NPI Information

NPI: 1134064652
Provider Name: NEURAL VITA THERAPEUTICS
Classification: Portable X-ray and/or Other Portable Diagnostic Imaging Supplier - 335V00000X
Entity Type: Organization
Address: 1804 BACON ST
SAN DIEGO, CA
ZIP 92107
Phone: (516) 395-2167

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NPI Details

NEURAL VITA THERAPEUTICS is a portable x ray and or other portable diagnostic imaging supplier in San Diego, CA. The provider is a supplier that provides one or more of the following portable services, including but not limited to, x-ray, electrocardiogram (EKG), long-term EKG (Holter Monitor), bone densitometry, sonography, and other imaging services in accordance with all state and federal requirements, under the general supervision of a qualified physician. All necessary resources are transported to the patient's location where the services are performed. NEURAL VITA THERAPEUTICS NPI is 1134064652. The provider is registered as an organization entity type.

The provider's business location address is:

1804 BACON ST
SAN DIEGO, CA
ZIP 92107-004
Phone: (516) 395-2167

The provider's authorized official is Jesse James Fowler .
The authorized official title is Coo and has the following contact phone number (516) 395-2167.

The enumeration date for this NPI number is 4/21/2026 and was last updated on 4/21/2026.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	Primary
1	251K00000X	Public Health or Welfare		No
2	251S00000X	Community/Behavioral Health		No
3	251V00000X	Voluntary or Charitable		No
4	252Y00000X	Early Intervention Provider Agency		No
5	261QM1102X	Clinic/Center	Military Outpatient Operational (Transportable) Component	No
6	261QP2000X	Clinic/Center	Physical Therapy	No
7	261QR1100X	Clinic/Center	Research	No
8	332U00000X	Home Delivered Meals		No
9	343900000X	Non-emergency Medical Transport (VAN)		No
10	251F00000X	Home Infusion		No
11	174200000X	Meals		No
12	251B00000X	Case Management		No
13	251E00000X	Home Health		No
14	335V00000X	Portable X-ray and/or Other Portable Diagnostic Imaging Supplier		Yes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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