Healthcare Provider Details

I. General information

NPI: 1952687634
Provider Name (Legal Business Name): VISTA HILL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2011
Last Update Date: 10/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1029 N BROADWAY
ESCONDIDO CA
92026-3043
US

IV. Provider business mailing address

1029 N BROADWAY
ESCONDIDO CA
92026-3043
US

V. Phone/Fax

Practice location:
  • Phone: 760-489-4126
  • Fax:
Mailing address:
  • Phone: 760-489-4126
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: KAREN GIANNINI
Title or Position: CLINICAL PROGRAM DIRECTOR
Credential:
Phone: 760-489-4126