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General NPI Number Information
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NPI Number | 1356755516
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Entity Type | Organization
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Legal Business Name | VIBRANT AMERICA CLINICAL LABORATORY
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Dates
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Enumeration Date | 06/16/2014
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Last Update Date | 06/16/2014
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Provider Practice Location Address
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Address Line | 1021 HOWARD AVE SUITE B
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City | SAN CARLOS
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State | CA
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Zip | 94070-4028
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Country | US
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Telephone | 650-226-3381
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Fax | 650-226-3381
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Provider Business Mailing Address
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Address Line | 1021 HOWARD AVE SUITE B
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City | SAN CARLOS
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State | CA
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Zip | 94070-4028
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Country | US
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Telephone | 650-226-3381
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Fax | 650-226-3381
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Authorized Official
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Title or Position | CEO
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Name | JOHN J RAJASEKARAN
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Credential |
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Telephone | 650-808-5824
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number | CLF 00346278
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License Number State | CA
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