Provider Demographics
NPI:1851603278
Name:VISTA COMPLETE CARE, INC.
Entity Type:Organization
Organization Name:VISTA COMPLETE CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:STEPHEN
Authorized Official - Last Name:SEWELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:530-885-3951
Mailing Address - Street 1:13555 BOWMAN RD STE 100
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:CA
Mailing Address - Zip Code:95603-3197
Mailing Address - Country:US
Mailing Address - Phone:530-885-3951
Mailing Address - Fax:530-885-3932
Practice Address - Street 1:13555 BOWMAN RD STE 100
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:CA
Practice Address - Zip Code:95603-3197
Practice Address - Country:US
Practice Address - Phone:530-885-3951
Practice Address - Fax:530-885-3932
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-14
Last Update Date:2010-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA87909207Q00000X
261QP2000X, 261QU0200X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent CareGroup - Multi-Specialty
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
BE326OtherPTAN
1609979723OtherNPI
BE326OtherPTAN