Provider Demographics
NPI:1558801829
Name:VANGUARD MEDICAL CORPORATION
Entity Type:Organization
Organization Name:VANGUARD MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:NOVIRA
Authorized Official - Middle Name:
Authorized Official - Last Name:SUNNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:661-599-5310
Mailing Address - Street 1:565 KERN ST
Mailing Address - Street 2:
Mailing Address - City:SHAFTER
Mailing Address - State:CA
Mailing Address - Zip Code:93263-2133
Mailing Address - Country:US
Mailing Address - Phone:661-746-4937
Mailing Address - Fax:661-746-3389
Practice Address - Street 1:845 7TH STREET
Practice Address - Street 2:
Practice Address - City:WASCO
Practice Address - State:CA
Practice Address - Zip Code:93280-1919
Practice Address - Country:US
Practice Address - Phone:661-746-4937
Practice Address - Fax:661-746-3389
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-06
Last Update Date:2023-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health