1659498228 NPI number — VISTA GUIDANCE CENTERS, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659498228 NPI number — VISTA GUIDANCE CENTERS, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VISTA GUIDANCE CENTERS, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1659498228
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 7369
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
REDLANDS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92375-0369
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
909-335-7067
Provider Business Mailing Address Fax Number:
909-792-2045

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
955 N D ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN BERNARDINO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92410-3519
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
909-885-4645
Provider Business Practice Location Address Fax Number:
909-885-8574
Provider Enumeration Date:
03/26/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BORJA
Authorized Official First Name:
SONIA
Authorized Official Middle Name:
JENNY
Authorized Official Title or Position:
DIRECTOR OF FINANCE
Authorized Official Telephone Number:
909-335-7067

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 36BT , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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