Healthcare Provider Details

I. General information

NPI: 1083174684
Provider Name (Legal Business Name): TIBUCIO VASQUEZ HEALTH CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2019
Last Update Date: 08/04/2021
Certification Date: 08/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23640 REED WAY
HAYWARD CA
94541-7326
US

IV. Provider business mailing address

22331 MISSION BLVD
HAYWARD CA
94541-3911
US

V. Phone/Fax

Practice location:
  • Phone: 510-471-5880
  • Fax:
Mailing address:
  • Phone: 510-471-5880
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: ANDREA SCHWAB-GALINDO
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 510-460-3855