Provider Demographics
NPI:1942970124
Name:VANGUARD MEDICAL CORPORATION
Entity Type:Organization
Organization Name:VANGUARD MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:NOVIRA
Authorized Official - Middle Name:
Authorized Official - Last Name:SUNNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:661-599-5310
Mailing Address - Street 1:565 KERN ST
Mailing Address - Street 2:
Mailing Address - City:SHAFTER
Mailing Address - State:CA
Mailing Address - Zip Code:93263-2133
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1100 BEAR MOUNTAIN BLVD
Practice Address - Street 2:
Practice Address - City:ARVIN
Practice Address - State:CA
Practice Address - Zip Code:93203
Practice Address - Country:US
Practice Address - Phone:661-459-1020
Practice Address - Fax:661-459-3535
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-17
Last Update Date:2021-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health