Provider Demographics
NPI:1891911681
Name:VISTA COMMUNITY CLINIC - PIER VIEW WAY DISPENSARY
Entity Type:Organization
Organization Name:VISTA COMMUNITY CLINIC - PIER VIEW WAY DISPENSARY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REVENUE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:
Authorized Official - Last Name:MUENZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-726-0065
Mailing Address - Street 1:1000 VALE TERRACE DR
Mailing Address - Street 2:
Mailing Address - City:VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:92084-5218
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:818 PIER VIEW WAY
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92054-2803
Practice Address - Country:US
Practice Address - Phone:760-631-5250
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VISTA COMMINTY CLINIC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-04-18
Last Update Date:2008-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACLN932332900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0540319OtherNATIONAL ASSOCIATION OF BOARDS OF PHARMACIES