Provider Demographics
NPI:1881945905
Name:VISTA BEHAVIORAL HEALTH, INC
Entity type:Organization
Organization Name:VISTA BEHAVIORAL HEALTH, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:OCHUKO
Authorized Official - Middle Name:GREGSON
Authorized Official - Last Name:DIAMREYOU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:909-919-7727
Mailing Address - Street 1:10630 TOWN CENTER DRIVE
Mailing Address - Street 2:STE 110
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730
Mailing Address - Country:US
Mailing Address - Phone:909-919-7727
Mailing Address - Fax:909-191-2035
Practice Address - Street 1:10630 TOWN CENTER DRIVE.
Practice Address - Street 2:STE 110
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730
Practice Address - Country:US
Practice Address - Phone:909-919-7727
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-28
Last Update Date:2012-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2084P0800X
CAA664322084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty