Provider Demographics
NPI:1942817804
Name:LA VISTA HEALTH
Entity Type:Organization
Organization Name:LA VISTA HEALTH
Other - Org Name:LA VISTA HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:A
Authorized Official - Last Name:TREVELLINE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:724-462-3975
Mailing Address - Street 1:1111 GRAND AVE STE L
Mailing Address - Street 2:
Mailing Address - City:DIAMOND BAR
Mailing Address - State:CA
Mailing Address - Zip Code:91765-4172
Mailing Address - Country:US
Mailing Address - Phone:909-551-0205
Mailing Address - Fax:909-345-7084
Practice Address - Street 1:1111 GRAND AVE STE L
Practice Address - Street 2:
Practice Address - City:DIAMOND BAR
Practice Address - State:CA
Practice Address - Zip Code:91765-4172
Practice Address - Country:US
Practice Address - Phone:909-551-0205
Practice Address - Fax:909-345-7084
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-24
Last Update Date:2021-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty