MEDICARE: VISTA PACIFICA ENTERPRISES INC.

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	314000000X	Skilled Nursing Facility	250000118	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1588734164
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VISTA PACIFICA ENTERPRISES INC.

Provider Business Mailing Address
First Line	:	3674 PACIFIC AVE
Second Line	:
City	:	RIVERSIDE
State	:	CA
Zip	:	92509-1948
Country	:	US
Telephone Number	:	951-682-4833
Fax Number	:	951-682-1503

Provider Business Practice Location Address
First Line	:	3674 PACIFIC AVE
Second Line	:
City	:	RIVERSIDE
State	:	CA
Zip	:	92509-1948
Country	:	US
Telephone Number	:	951-682-4833
Fax Number	:	951-682-1503

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MR. ALLAN ENGELAUF
Credential	:
Telephone Number	:	951-682-4833

Provider Enumeration Date	:	11/09/2006
Last Update Date	:	05/01/2018

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