Provider Demographics
NPI:1790256808
Name:TIBURCIO VASQUEZ HEALTH CENTER, INC.
Entity Type:Organization
Organization Name:TIBURCIO VASQUEZ HEALTH CENTER, INC.
Other - Org Name:CHABOT COLLEGE
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:510-471-5907
Mailing Address - Fax:510-690-0703
Practice Address - Street 1:25555 HESPERIAN BLVD RM 2315
Practice Address - Street 2:
Practice Address - City:HAYWARD
Practice Address - State:CA
Practice Address - Zip Code:94545-2447
Practice Address - Country:US
Practice Address - Phone:510-471-5907
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TIBUCIO VASQUEZ HEALTH CENTER, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-12-16
Last Update Date:2022-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NONEOtherNONE