Healthcare Provider Details

I. General information

NPI: 1851940308
Provider Name (Legal Business Name): VISTA PRADO INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/07/2019
Last Update Date: 04/15/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 POWER DR
VALLEJO CA
94589-2529
US

IV. Provider business mailing address

4518 54TH ST
SAN DIEGO CA
92115-3527
US

V. Phone/Fax

Practice location:
  • Phone: 707-343-9352
  • Fax: 707-205-1515
Mailing address:
  • Phone: 619-623-4000
  • Fax: 619-286-8534

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code311500000X
TaxonomyAlzheimer Center (Dementia Center)
License Number
License Number State

VIII. Authorized Official

Name: LINDA CHO
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 619-623-4000