Healthcare Provider Details

I. General information

NPI: 1235133711
Provider Name (Legal Business Name): VIBRANTCARE OUTPATIENT REHABILITATION OF CALIFORNIA INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2005
Last Update Date: 11/22/2023
Certification Date: 11/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2160 APPIAN WAY STE 101
PINOLE CA
94564-2524
US

IV. Provider business mailing address

PO BOX 840343
LOS ANGELES CA
90084-0343
US

V. Phone/Fax

Practice location:
  • Phone: 510-724-1248
  • Fax: 510-724-5720
Mailing address:
  • Phone: 916-789-8115
  • Fax: 916-773-1481

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. DAVID SMITH
Title or Position: CEO
Credential:
Phone: 916-782-1212