Healthcare Provider Details

I. General information

NPI: 1467834085
Provider Name (Legal Business Name): VISTA DEL SOL HEALTH SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2015
Last Update Date: 06/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4323 COOLIDGE AVE
LOS ANGELES CA
90066-5905
US

IV. Provider business mailing address

11620 W WASHINGTON BLVD
LOS ANGELES CA
90066-5916
US

V. Phone/Fax

Practice location:
  • Phone: 310-390-9045
  • Fax: 310-391-7677
Mailing address:
  • Phone: 310-390-9045
  • Fax: 310-391-7677

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number191601231
License Number StateCA

VIII. Authorized Official

Name: JAMES R PREIMESBERGER
Title or Position: PRESIDENT
Credential:
Phone: 310-390-9045