Healthcare Provider Details

I. General information

NPI: 1942450820
Provider Name (Legal Business Name): COMPASS VISTA, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2008
Last Update Date: 09/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

611 STAPLES RD
SAN MARCOS TX
78666-1426
US

IV. Provider business mailing address

611 STAPLES RD
SAN MARCOS TX
78666-1426
US

V. Phone/Fax

Practice location:
  • Phone: 512-535-0322
  • Fax: 512-535-6002
Mailing address:
  • Phone: 512-535-0322
  • Fax: 512-535-6002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. MICHAEL CANDELARIO
Title or Position: DIRECTOR OF OPERATIONS
Credential:
Phone: 512-535-0322