Healthcare Provider Details

I. General information

NPI: 1669387155
Provider Name (Legal Business Name): COLLECTIVE IMPACT SOLUTIONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2026
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2022 STARGAZER LN
VISTA CA
92084-2416
US

IV. Provider business mailing address

1255 E VISTA WAY # 225
VISTA CA
92084-4039
US

V. Phone/Fax

Practice location:
  • Phone: 760-691-4551
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: REBECCA CELES-MENDIOLA
Title or Position: CHIEF EXECUTIVE OFFICER
Credential: ED.D
Phone: 760-691-4551