Provider Demographics
NPI:1689748485
Name:VISTA GROUP
Entity Type:Organization
Organization Name:VISTA GROUP
Other - Org Name:ROBERT L VANDE STEEG
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:L
Authorized Official - Last Name:VANDE STEEG
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:562-810-2740
Mailing Address - Street 1:4050 KATELLA AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:LOS ALAMITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90720-3434
Mailing Address - Country:US
Mailing Address - Phone:562-810-2740
Mailing Address - Fax:
Practice Address - Street 1:4050 KATELLA AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:LOS ALAMITOS
Practice Address - State:CA
Practice Address - Zip Code:90720-3434
Practice Address - Country:US
Practice Address - Phone:562-810-2740
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-20
Last Update Date:2012-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY19764103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q48580Medicare UPIN
CACP19764Medicare ID - Type Unspecified