Provider Demographics
NPI:1497805790
Name:TIBURCIO VASQUEZ HEALTH CENTER, INC.
Entity Type:Organization
Organization Name:TIBURCIO VASQUEZ HEALTH CENTER, INC.
Other - Org Name:LOGAN HEALTH CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHWAB-GALINDO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:510-460-3855
Mailing Address - Street 1:33255 NINTH ST
Mailing Address - Street 2:
Mailing Address - City:UNION CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94587
Mailing Address - Country:US
Mailing Address - Phone:510-471-5880
Mailing Address - Fax:540-471-9051
Practice Address - Street 1:1800 H ST RM 80
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:CA
Practice Address - Zip Code:94587-3321
Practice Address - Country:US
Practice Address - Phone:510-471-5907
Practice Address - Fax:510-476-0404
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-11
Last Update Date:2021-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA140000504STATELICENS261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHAP70644FOtherFAMILY PACT SERVICES
CAFHC70644FMedicaid
CAFHC70644FMedicaid