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General NPI Number Information
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NPI Number | 1083810790
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Entity Type | Organization
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Legal Business Name | VISTA HEALTHCARE, LLC
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Dates
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Enumeration Date | 06/21/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 10841 WHITE OAK AVE SUITE 205
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City | RANCHO CUCAMONGA
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State | CA
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Zip | 91730-3811
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Country | US
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Telephone | 909-581-7272
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Fax | 909-581-7277
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Provider Business Mailing Address
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Address Line | 10841 WHITE OAK AVE SUITE 205
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City | RANCHO CUCAMONGA
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State | CA
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Zip | 91730-3811
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Country | US
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Telephone | 909-581-7272
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Fax | 909-581-7277
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Authorized Official
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Title or Position | SENIOR VICE PRESIDENT
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Name | MARC C FERRELL
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Credential |
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Telephone | 909-581-7272
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305S00000X
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Taxonomy Name | Point of Service
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License Number |
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License Number State | CA
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