Healthcare Provider Details

I. General information

NPI: 1275533929
Provider Name (Legal Business Name): VISTA WOODS HEALTH ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2005
Last Update Date: 02/17/2021
Certification Date: 02/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 WESTWOOD RD
VISTA CA
92083-5123
US

IV. Provider business mailing address

2000 WESTWOOD RD
VISTA CA
92083-5123
US

V. Phone/Fax

Practice location:
  • Phone: 760-630-2273
  • Fax: 760-630-0913
Mailing address:
  • Phone: 760-630-2273
  • Fax: 760-630-0913

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number080000353
License Number StateCA

VIII. Authorized Official

Name: MS. SOON BURNAM
Title or Position: AUTHORIZED AGENT
Credential:
Phone: 949-540-1249