Healthcare Provider Details

I. General information

NPI: 1760740138
Provider Name (Legal Business Name): VISTA COMMUNITY HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2012
Last Update Date: 04/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14117 HUBBARD ST SUITE M
SYLMAR CA
91342-4713
US

IV. Provider business mailing address

14117 HUBBARD ST SUITE M
SYLMAR CA
91342-4713
US

V. Phone/Fax

Practice location:
  • Phone: 818-833-3306
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number StateCA

VIII. Authorized Official

Name: DELINA JOHNSON
Title or Position: CEO
Credential: RN, PHN
Phone: 818-833-3306