Organization
VIBRANT AMERICA LLC
Active
Other names
Vibrant America Clinical Lab
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN JAGAZEEL RAJASEKARAN (CEO)
(408) 203-9383
Entity
Organization
Contact information
Practice address
1021 HOWARD AVENUE, SUITE B, SAN CARLOS, CA 94070-4034
(650) 830-5575
(650) 508-8260
Mailing address
1021 HOWARD AVENUE, SUITE B, SAN CARLOS, CA 94070-4034
(650) 830-5575
(650) 508-8260
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
08/01/2014
Last updated
01/13/2015
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