Healthcare Provider Details

I. General information

NPI: 1497668701
Provider Name (Legal Business Name): VIBRANT HEALTHCARE NURSING CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2026
Last Update Date: 09/26/2026
Certification Date: 09/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3621 MARTIN LUTHER KING JR BLVD STE 6
LYNWOOD CA
90262-3512
US

IV. Provider business mailing address

PO BOX 15402
LONG BEACH CA
90815-0402
US

V. Phone/Fax

Practice location:
  • Phone: 562-912-8904
  • Fax:
Mailing address:
  • Phone: 562-912-8904
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: TRICIA ALIAZIS
Title or Position: OWNER
Credential:
Phone: 562-912-8904