Healthcare Provider Details

I. General information

NPI: 1851603278
Provider Name (Legal Business Name): VISTA COMPLETE CARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2010
Last Update Date: 07/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13555 BOWMAN RD STE 100
AUBURN CA
95603-3197
US

IV. Provider business mailing address

13555 BOWMAN RD STE 100
AUBURN CA
95603-3197
US

V. Phone/Fax

Practice location:
  • Phone: 530-885-3951
  • Fax: 530-885-3932
Mailing address:
  • Phone: 530-885-3951
  • Fax: 530-885-3932

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA87909
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name: DANIEL STEPHEN SEWELL
Title or Position: OWNER
Credential: M.D.
Phone: 530-885-3951