MEDICARE: VIBRANTCARE OUTPATIENT REHABILITATION OF CALIFORNIA, 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	261QP2000X	Physical Therapy Clinic/Center

General Provider Information

NPI Number	:	1487688008
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VIBRANTCARE OUTPATIENT REHABILITATION OF CALIFORNIA, INC.

Provider Business Mailing Address
First Line	:	PO BOX 840343
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90084-0343
Country	:	US
Telephone Number	:	916-789-8115
Fax Number	:

Provider Business Practice Location Address
First Line	:	3000 W MACARTHUR BLVD STE 600
Second Line	:
City	:	SANTA ANA
State	:	CA
Zip	:	92704-6982
Country	:	US
Telephone Number	:	717-975-4503
Fax Number	:

Authorized Official
Title or Position	:	VP OF REVENUE CYCLE MANAGEMENT
Name	:	CYNTHIA MCCORMICK
Credential	:
Telephone Number	:	916-789-8115

Provider Enumeration Date	:	07/10/2006
Last Update Date	:	11/22/2023

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