Healthcare Provider Details

I. General information

NPI: 1710206958
Provider Name (Legal Business Name): VISTA HOSPITAL OF SOUTH BAY, LP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2010
Last Update Date: 05/27/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21530 PIONEER BLVD
HAWAIIAN GARDENS CA
90716-2608
US

IV. Provider business mailing address

1246 W 155TH ST
GARDENA CA
90247-4011
US

V. Phone/Fax

Practice location:
  • Phone: 562-860-4488
  • Fax: 562-860-4489
Mailing address:
  • Phone: 310-323-5330
  • Fax: 310-768-2265

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282E00000X
TaxonomyLong Term Care Hospital
License Number930000037
License Number StateCA

VIII. Authorized Official

Name: MR. MARC C. FERRELL
Title or Position: SENIOR VICE-PRESIDENT
Credential:
Phone: 909-581-7272