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General NPI Number Information
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NPI Number | 1366859506
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Entity Type | Organization
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Legal Business Name | VISTA COMMUNITY CLINIC
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Dates
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Enumeration Date | 07/21/2014
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Last Update Date | 07/21/2014
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Provider Practice Location Address
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Address Line | 1000 VALE TERRACE DR
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City | VISTA
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State | CA
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Zip | 92084-5218
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Country | US
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Telephone | 760-631-5000
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Fax |
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Provider Business Mailing Address
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Address Line | 1000 VALE TERRACE DR
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City | VISTA
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State | CA
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Zip | 92084-5218
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DENTAL HYGIENIST
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Name | JONATHAN NAVARRO
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Credential |
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Telephone | 760-445-7043
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number | 28096
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License Number State | CA
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