MEDICARE: MOUNTAIN VISTA MEDICAL CENTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	282N00000X	General Acute Care Hospital		CA

General Provider Information

NPI Number	:	1043610769
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOUNTAIN VISTA MEDICAL CENTER

Provider Business Mailing Address
First Line	:	8168 PALM VIEW LN
Second Line	:
City	:	RIVERSIDE
State	:	CA
Zip	:	92508-6610
Country	:	US
Telephone Number	:	951-850-3444
Fax Number	:

Provider Business Practice Location Address
First Line	:	8168 PALM VIEW LN
Second Line	:
City	:	RIVERSIDE
State	:	CA
Zip	:	92508
Country	:	US
Telephone Number	:	951-850-3444
Fax Number	:

Authorized Official
Title or Position	:	CRNA
Name	:	NAZARET TOMASSIAN
Credential	:	CRNA
Telephone Number	:	951-850-3444

Provider Enumeration Date	:	08/29/2014
Last Update Date	:	08/29/2014

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