Healthcare Provider Details

I. General information

NPI: 1447443023
Provider Name (Legal Business Name): VISTA DEL SOL HEALTH SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/27/2007
Last Update Date: 02/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11620 W WASHINGTON BLVD
LOS ANGELES CA
90066-5916
US

IV. Provider business mailing address

5000 EXECUTIVE PKWY SUITE 150
SAN RAMON CA
94583-4210
US

V. Phone/Fax

Practice location:
  • Phone: 310-390-9045
  • Fax:
Mailing address:
  • Phone: 925-855-0881
  • Fax: 925-855-9297

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number910000037
License Number StateCA

VIII. Authorized Official

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