Basic Information
| Provider Information | |||||||||
| NPI: | 1487688008 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | VIBRANTCARE OUTPATIENT REHABILITATION OF CALIFORNIA, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 151 N SUNRISE AVE STE 902 | ||||||||
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| City: | ROSEVILLE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 956612929 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9167898115 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3000 W MACARTHUR BLVD STE 600 | ||||||||
| Address2: | |||||||||
| City: | SANTA ANA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 927046982 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7179754503 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/10/2006 | ||||||||
| LastUpdateDate: | 05/05/2022 | ||||||||
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| AuthorizedOfficialLastName: | MCCORMICK | ||||||||
| AuthorizedOfficialFirstName: | CYNTHIA | ||||||||
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| AuthorizedOfficialTitleorPosition: | VP OF REVENUE CYCLE MANAGEMENT | ||||||||
| AuthorizedOfficialTelephone: | 9167898115 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 05/05/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QP2000X | Y | Ambulatory Health Care Facilities | Clinic/Center | Physical Therapy |
No ID Information.