Healthcare Provider Details

I. General information

NPI: 1851300123
Provider Name (Legal Business Name): VISTA COMMUNITY CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2006
Last Update Date: 05/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

134 GRAPEVINE RD
VISTA CA
92083-4004
US

IV. Provider business mailing address

1000 VALE TERRACE DR
VISTA CA
92084-5218
US

V. Phone/Fax

Practice location:
  • Phone: 760-631-5030
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number080000002
License Number StateCA

VIII. Authorized Official

Name: MS. MICHELE LAMBERT
Title or Position: CFO
Credential:
Phone: 760-726-0065