Provider Demographics
NPI:1639264419
Name:VISTA FAMILY HEALTH CENTER,A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:VISTA FAMILY HEALTH CENTER,A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:
Authorized Official - Last Name:OLIVA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:760-941-7050
Mailing Address - Street 1:1070 S SANTA FE AVE STE 9
Mailing Address - Street 2:
Mailing Address - City:VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:92084-7010
Mailing Address - Country:US
Mailing Address - Phone:760-941-7050
Mailing Address - Fax:760-941-7142
Practice Address - Street 1:1070 S SANTA FE AVE STE 9
Practice Address - Street 2:
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92084-7010
Practice Address - Country:US
Practice Address - Phone:760-941-7050
Practice Address - Fax:760-941-7142
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2007-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA40155261QC1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1800XAmbulatory Health Care FacilitiesClinic/CenterCorporate Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA85393Medicare UPIN
ARA40155Medicare ID - Type UnspecifiedAND MEDICAL