Healthcare Provider Details

I. General information

NPI: 1407373921
Provider Name (Legal Business Name): TIBURCIO VASQUEZ HEALTH CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2017
Last Update Date: 07/06/2021
Certification Date: 07/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1633 EAST AVE
HAYWARD CA
94541-5314
US

IV. Provider business mailing address

22331 MISSION BLVD
HAYWARD CA
94541-3911
US

V. Phone/Fax

Practice location:
  • Phone: 510-471-5907
  • Fax:
Mailing address:
  • Phone: 510-690-6052
  • Fax: 510-690-0703

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number14000706
License Number State

VIII. Authorized Official

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