Healthcare Provider Details

I. General information

NPI: 1497805790
Provider Name (Legal Business Name): TIBURCIO VASQUEZ HEALTH CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2007
Last Update Date: 07/06/2021
Certification Date: 07/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 H ST RM 80
UNION CITY CA
94587-3321
US

IV. Provider business mailing address

33255 NINTH ST
UNION CITY CA
94587
US

V. Phone/Fax

Practice location:
  • Phone: 510-471-5907
  • Fax: 510-476-0404
Mailing address:
  • Phone: 510-471-5880
  • Fax: 540-471-9051

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number140000504STATELICENS
License Number StateCA

VIII. Authorized Official

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