Provider Demographics
NPI:1639272677
Name:VISTA USD
Entity Type:Organization
Organization Name:VISTA USD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF SPECIAL EDUCATION
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:S
Authorized Official - Last Name:HANNAMAN
Authorized Official - Suffix:
Authorized Official - Credentials:EDD
Authorized Official - Phone:760-726-2170
Mailing Address - Street 1:1234 ARCADIA AVE
Mailing Address - Street 2:
Mailing Address - City:VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:92084-3404
Mailing Address - Country:US
Mailing Address - Phone:760-726-2170
Mailing Address - Fax:760-941-4524
Practice Address - Street 1:1234 ARCADIA AVE
Practice Address - Street 2:
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92084-3404
Practice Address - Country:US
Practice Address - Phone:760-726-2170
Practice Address - Fax:760-941-4524
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASS3768452Medicaid