Provider Demographics
NPI:1518784347
Name:VISTA HEALTH AND WELLNESS
Entity type:Organization
Organization Name:VISTA HEALTH AND WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:GENER
Authorized Official - Middle Name:
Authorized Official - Last Name:BENARDO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-410-2569
Mailing Address - Street 1:16031 N 16TH ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85022-3328
Mailing Address - Country:US
Mailing Address - Phone:602-410-2569
Mailing Address - Fax:
Practice Address - Street 1:1550 BRIDGER RD NE
Practice Address - Street 2:
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87144-1579
Practice Address - Country:US
Practice Address - Phone:602-410-2569
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-23
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center