MEDICARE: VISTA DEL MAR CHILD AND FAMILY SERVICES

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	171M00000X	Case Manager/Care Coordinator
2	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1053146407
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VISTA DEL MAR CHILD AND FAMILY SERVICES

Provider Business Mailing Address
First Line	:	6926 MELROSE AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90038-3306
Country	:	US
Telephone Number	:	323-934-7979
Fax Number	:	323-934-0514

Provider Business Practice Location Address
First Line	:	6926 MELROSE AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90038-3306
Country	:	US
Telephone Number	:	323-934-7979
Fax Number	:	323-934-0514

Authorized Official
Title or Position	:	DIRECTOR QUALITY, STANDARDS AND COM
Name	:	CHERYL CARRINGTON
Credential	:
Telephone Number	:	310-836-1223

Provider Enumeration Date	:	09/05/2024
Last Update Date	:	01/06/2025

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