Healthcare Provider Details

I. General information

NPI: 1023005683
Provider Name (Legal Business Name): NEW VISTA HEALTH SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2005
Last Update Date: 10/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1516 SAWTELLE BLVD
LOS ANGELES CA
90025-3207
US

IV. Provider business mailing address

1516 SAWTELLE BLVD
LOS ANGELES CA
90025-3207
US

V. Phone/Fax

Practice location:
  • Phone: 310-477-5501
  • Fax: 310-473-8363
Mailing address:
  • Phone: 310-477-5501
  • Fax: 310-473-8363

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number910000018
License Number StateCA

VIII. Authorized Official

Name: MRS. MARIE LOPEZ DEE
Title or Position: EXECUTIVE DIRECTOR
Credential: NHA
Phone: 310-477-5501