Healthcare Provider Details

I. General information

NPI: 1548937071
Provider Name (Legal Business Name): TIBURCIO VASQUEZ HEALTH CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2021
Last Update Date: 08/25/2021
Certification Date: 08/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33255 9TH ST
UNION CITY CA
94587-2137
US

IV. Provider business mailing address

22331 MISSION BLVD
HAYWARD CA
94541-3911
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

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