Vibrant America LLC

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

License

CLF 00346278 Issued in CA

Legal business name

VIBRANT AMERICA LLC

Doing business as

Vibrant America Clinical Lab

Practice address

1021 Howard Avenue
Suite B
San Carlos, CA 94070-4034

Phone

(650) 830-5575

Fax

(650) 508-8260

NPI assigned

Aug 1, 2014

Organization subpart

No

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

Authorized official

Name

John Jagazeel Rajasekaran

Title

Ceo

Phone

(408) 203-9383

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Vibrant America Clinical Lab Doing business as

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

{
    "created_epoch": "1406851200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1421107200000",
    "number": "1407264500",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1021 HOWARD AVENUE",
            "address_2": "SUITE B",
            "city": "SAN CARLOS",
            "state": "CA",
            "postal_code": "940704034",
            "telephone_number": "650-830-5575",
            "fax_number": "650-508-8260"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1021 HOWARD AVENUE",
            "address_2": "SUITE B",
            "city": "SAN CARLOS",
            "state": "CA",
            "postal_code": "940704034",
            "telephone_number": "650-830-5575",
            "fax_number": "650-508-8260"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VIBRANT AMERICA LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-08-01",
        "last_updated": "2015-01-13",
        "status": "A",
        "authorized_official_last_name": "RAJASEKARAN",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "JAGAZEEL",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "408-203-9383"
    },
    "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": [
        {
            "organization_name": "Vibrant America Clinical Lab",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Taylor Ann Veach
• Uriel Velazquez, B.S.
• Andrew Vercellino, DC
• Inge L Verschueren, OTR/L
• Vibrant America Clinical Laboratory
• Vibrant Genomics LLC.
• Vibrantcare Outpatient Rehabilitation of California Inc
• Vibrantcare Rehabilitation
• Jorge Luis Vidarte
• Elaina Claudine Vielbaum

• 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 Jan 13, 2015; 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.