Provider Demographics
NPI:1720405491
Name:TIBURCIO VASQUEZ HEALTH CENTER, INC.
Entity Type:Organization
Organization Name:TIBURCIO VASQUEZ HEALTH CENTER, INC.
Other - Org Name:SAN LEANDRO MOBILE VAN
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 1:22331 MISSION BLVD
Mailing Address - Street 2:
Mailing Address - City:HAYWARD
Mailing Address - State:CA
Mailing Address - Zip Code:94541-3911
Mailing Address - Country:US
Mailing Address - Phone:510-690-6052
Mailing Address - Fax:
Practice Address - Street 1:16110 E 14TH ST
Practice Address - Street 2:
Practice Address - City:SAN LEANDRO
Practice Address - State:CA
Practice Address - Zip Code:94578-3002
Practice Address - Country:US
Practice Address - Phone:510-471-5907
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-19
Last Update Date:2022-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
No171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty
No261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health