MEDICARE: VIBS CO.

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	171W00000X	Contractor

General Provider Information

NPI Number	:	1023228905
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VIBS CO.

Provider Business Mailing Address
First Line	:	1412 VAL VERDE PL
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91208-1120
Country	:	US
Telephone Number	:	818-248-1222
Fax Number	:	818-248-1877

Provider Business Practice Location Address
First Line	:	1412 VAL VERDE PL
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91208-1120
Country	:	US
Telephone Number	:	818-248-1222
Fax Number	:	818-248-1877

Authorized Official
Title or Position	:	PRESIDENT
Name	:	HENRIK YEKIKAN
Credential	:
Telephone Number	:	818-248-1222

Provider Enumeration Date	:	05/22/2007
Last Update Date	:	11/19/2007

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