Vibrant America Clinical Laboratory

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

License

CLF 00346278 Issued in CA

Legal business name

VIBRANT AMERICA CLINICAL LABORATORY

Practice address

1021 Howard Ave
Suite B
San Carlos, CA 94070-4028

Phone

(650) 226-3381

Fax

(650) 226-3381

NPI assigned

Jun 16, 2014

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

John J Rajasekaran

Title

Ceo

Phone

(650) 808-5824

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1402876800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1402876800000",
    "number": "1356755516",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1021 HOWARD AVE",
            "address_2": "SUITE B",
            "city": "SAN CARLOS",
            "state": "CA",
            "postal_code": "940704028",
            "telephone_number": "650-226-3381",
            "fax_number": "650-226-3381"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1021 HOWARD AVE",
            "address_2": "SUITE B",
            "city": "SAN CARLOS",
            "state": "CA",
            "postal_code": "940704028",
            "telephone_number": "650-226-3381",
            "fax_number": "650-226-3381"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VIBRANT AMERICA CLINICAL LABORATORY",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-06-16",
        "last_updated": "2014-06-16",
        "status": "A",
        "authorized_official_last_name": "RAJASEKARAN",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "650-808-5824"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "CA",
            "license": "CLF 00346278",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLIA NUMBER",
            "identifier": "05D2078809",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CALIFORNIA LABORATORY LICENSE",
            "identifier": "CLF 00346278",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Fotini Vavelidis, MS,CGC
• Taylor Ann Veach
• Uriel Velazquez, B.S.
• Andrew Vercellino, DC
• Inge L Verschueren, OTR/L
• Vibrant America LLC
• Vibrant Genomics LLC.
• Vibrantcare Outpatient Rehabilitation of California Inc
• Vibrantcare Rehabilitation
• Jorge Luis Vidarte

• Clinical Medical Laboratory in San Carlos, CA
• Providers in San Carlos, CA by specialty
• Clinical Medical Laboratory in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.