Healthcare Provider Details

I. General information

NPI: 1265604466
Provider Name (Legal Business Name): COMPASS VISTA SOLUTIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2008
Last Update Date: 04/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5501 S EXPRESSWAY 77
HARLINGEN TX
78550-3213
US

IV. Provider business mailing address

611 STAPLES RD
SAN MARCOS TX
78666-1426
US

V. Phone/Fax

Practice location:
  • Phone: 956-365-1167
  • Fax: 956-365-1073
Mailing address:
  • Phone: 512-535-0322
  • Fax: 866-361-1103

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: JULIE CANDELARIO
Title or Position: ADMINISTRATION
Credential:
Phone: 512-535-0322