Provider Demographics
NPI:1891171526
Name:VIDA VIBRANTE TRANSITIONAL CARE GROUP INC
Entity Type:Organization
Organization Name:VIDA VIBRANTE TRANSITIONAL CARE GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MIN
Authorized Official - Middle Name:MIN
Authorized Official - Last Name:HLAING
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:209-662-3856
Mailing Address - Street 1:2036 SNOWBIRD DR
Mailing Address - Street 2:
Mailing Address - City:LODI
Mailing Address - State:CA
Mailing Address - Zip Code:95242-4754
Mailing Address - Country:US
Mailing Address - Phone:209-662-3856
Mailing Address - Fax:
Practice Address - Street 1:2036 SNOWBIRD DR
Practice Address - Street 2:
Practice Address - City:LODI
Practice Address - State:CA
Practice Address - Zip Code:95242-4754
Practice Address - Country:US
Practice Address - Phone:209-662-3856
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-05
Last Update Date:2015-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA104774208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty