Provider Demographics
NPI:1669705836
Name:VISTA HILLS
Entity type:Organization
Organization Name:VISTA HILLS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LVN
Authorized Official - Prefix:MISS
Authorized Official - First Name:ANALYN
Authorized Official - Middle Name:B
Authorized Official - Last Name:GONZALES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:858-571-1964
Mailing Address - Street 1:2851 MEADOW LARK DR
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-2709
Mailing Address - Country:US
Mailing Address - Phone:858-571-1964
Mailing Address - Fax:858-571-1967
Practice Address - Street 1:2851 MEADOW LARK DR
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-2709
Practice Address - Country:US
Practice Address - Phone:858-571-1964
Practice Address - Fax:858-571-1967
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-04
Last Update Date:2009-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA951944230302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization