Provider Demographics
NPI:1114343241
Name:VIBRANT HEALTH MD, PLLC
Entity Type:Organization
Organization Name:VIBRANT HEALTH MD, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:WAKI HO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-918-7222
Mailing Address - Street 1:6101 CHAPEL HILL BLVD
Mailing Address - Street 2:SUITE 206
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-8446
Mailing Address - Country:US
Mailing Address - Phone:214-918-7222
Mailing Address - Fax:214-614-9218
Practice Address - Street 1:9119 COCHRAN BLUFF LN
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75220-5235
Practice Address - Country:US
Practice Address - Phone:214-918-7222
Practice Address - Fax:214-614-9218
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VIBRANT HEALTH MD, PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-03-13
Last Update Date:2014-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM7734207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty