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General NPI Number Information
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NPI Number | 1891911681
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Entity Type | Organization
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Legal Business Name | VISTA COMMUNITY CLINIC - PIER VIEW WAY DISPENSARY
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Dates
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Enumeration Date | 04/18/2007
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Last Update Date | 05/27/2008
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Provider Practice Location Address
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Address Line | 818 PIER VIEW WAY
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City | OCEANSIDE
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State | CA
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Zip | 92054-2803
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Country | US
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Telephone | 760-631-5250
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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 | REVENUE MANAGER
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Name | MR. TRACY MUENZ
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Credential |
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Telephone | 760-726-0065
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332900000X
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Taxonomy Name | Non-Pharmacy Dispensing Site
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License Number | CLN932
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License Number State | CA
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