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Organization

VIBRANT AMERICA CLINICAL LABORATORY

Active
Organization subpart
No

Provider details

NPI number
Authorized official
JOHN J RAJASEKARAN (CEO)
(650) 808-5824
Entity
Organization

Contact information

Practice address
1021 HOWARD AVE, SUITE B, SAN CARLOS, CA 94070-4028
(650) 226-3381
(650) 226-3381
Mailing address
1021 HOWARD AVE, SUITE B, SAN CARLOS, CA 94070-4028
(650) 226-3381
(650) 226-3381

Taxonomy

Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
CLF 00346278
CA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
05D2078809
CLIA NUMBER
CA
01
CLF 00346278
CALIFORNIA LABORATORY LICENSE
CA
Enumeration date
06/16/2014
Last updated
06/16/2014
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