Provider Demographics
NPI:1205378437
Name:TRISTAR HOME VISIT PROVIDERS INC
Entity Type:Organization
Organization Name:TRISTAR HOME VISIT PROVIDERS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARIA VVCTORIA
Authorized Official - Middle Name:T
Authorized Official - Last Name:SALCEDO
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:909-565-8384
Mailing Address - Street 1:275 W HOSPITALITY LN STE 103A
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92408-3238
Mailing Address - Country:US
Mailing Address - Phone:909-565-8384
Mailing Address - Fax:909-575-6200
Practice Address - Street 1:275 W HOSPITALITY LN STE 103A
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92408-3238
Practice Address - Country:US
Practice Address - Phone:909-565-8384
Practice Address - Fax:909-575-6200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-04
Last Update Date:2016-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21506363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty