MEDICARE: VIBRANT HEALTH CARE, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	3554	AZ
2	207Q00000X	Family Medicine Physician
3	2081S0010X	Sports Medicine (Physical Medicine & Rehabilitation) Physician
4	251S00000X	Community/Behavioral Health Agency		AZ
5	261QM1300X	Multi-Specialty Clinic/Center

General Provider Information

NPI Number	:	1013441542
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VIBRANT HEALTH CARE, INC.

Provider Business Mailing Address
First Line	:	4900 N SCOTTSDALE RD STE 2400
Second Line	:
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85251-7652
Country	:	US
Telephone Number	:	480-383-3882
Fax Number	:

Provider Business Practice Location Address
First Line	:	4900 N SCOTTSDALE RD STE 2400
Second Line	:
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85251-7652
Country	:	US
Telephone Number	:	480-320-3004
Fax Number	:	480-383-6540

Authorized Official
Title or Position	:	PRESIDENT
Name	:	SARETTE ZECHARIA
Credential	:	PHD
Telephone Number	:	480-874-5806

Provider Enumeration Date	:	04/11/2017
Last Update Date	:	01/18/2019

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