VISTA COMMUNITY CLINIC (NPI# 1649662719) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1649662719 |
| Entity Type | Organization |
| Organization Name | VISTA COMMUNITY CLINIC |
| Practice Address |
30195 Fraser Dr Lake Elsinore CA 92530-7006 |
| Mailing Address |
1000 Vale Terrace Dr Vista CA 92084-5218 |
| Practice Telephone | 7606315000 |
| Mailing Telephone | 7606315000 |
| Enumeration Date | 2015-02-26 |
| Last Update Date | 2016-02-10 |
| Authorized Official Name | FERNANDO SANUDO (CEO) |
| Authorized Official Telephone | 7606315000 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QF0400X |
Clinic/Center Specialization: Federally Qualified Health Center (FQHC) |
Ambulatory Health Care Facilities |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1932562964 | Vista Community Clinic | Clinic/Center | 341 S. Hillcrest St., La Habra, CA 90631 | 2016-03-29 |
| 1346609971 | Vista Community Clinic | Clinic/Center | 311 Hillcrest St, La Habra, CA 90631-5340 | 2016-02-10 |
| 1437245412 | Vista Community Clinic | Clinic/Center | 517 N Horne St, Oceanside, CA 92054-2518 | 2006-10-05 |
| 1689760100 | Vista Community Clinic | Clinic/Center | 4700 North River Road, Oceanside, CA 92057 | 2006-10-04 |
| 1649363375 | Vista Community Clinic | Clinic/Center | 818 Pierview Way, Oceanside, CA 92054 | 2006-10-02 |
| 1578198503 | Vista Community Clinic | Dentist | 1910 Mission Ave Ste 4, Oceanside, CA 92058-7129 | 2020-03-10 |
| 1316501562 | Vista Community Clinic | Case Manager/Care Coordinator | 1000 Vale Terrace Dr, Vista, CA 92084-5218 | 2019-04-23 |
| 1467990614 | Vista Community Clinic | Clinic/Center | 105 Durian St, Vista, CA 92083-6205 | 2017-02-08 |
| 1497203541 | Vista Community Clinic | Clinic/Center | 201 S Harbor Blvd, La Habra, CA 90631-5654 | 2016-09-19 |
| 1598124083 | Vista Community Clinic | Clinic/Center | 1525 E 17th St, Unit #b, Santa Ana, CA 92705-8521 | 2016-02-12 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | VISTA COMMUNITY CLINIC | 1000 Vale Terrace Dr, Vista, CA 92084-5218 |
| Street Address |
30195 FRASER DR |
| City | LAKE ELSINORE |
| State | CA |
| Zip Code | 92530-7006 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679613236 | Gail Ann Mc Cabe | Social Worker | 30195 Fraser Dr, Lake Elsinore, CA 92530-7006 | 2007-02-06 |
| 1699038125 | Clint Ketchel | Family Medicine | 30195 Fraser Dr, Lake Elsinore, CA 92530-7006 | 2012-06-19 |
| 1447586615 | Joel M Switzer | Dentist | 30195 Fraser Dr, Lake Elsinore, CA 92530-7006 | 2009-10-23 |
| 1609012830 | Carla Patricia Campo | Dentist | 30195 Fraser Dr, Lake Elsinore, CA 92530-7006 | 2008-12-17 |
| 1407985948 | Imelda Gutierrez-hunt | Social Worker | 30195 Fraser Dr, Lake Elsinore, CA 92530-7006 | 2007-03-02 |
| 1154461051 | Menouchehr Bazyani | Pediatrics | 30195 Fraser Dr, Lake Elsinore, CA 92530-7006 | 2007-02-08 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1841801479 | Mercedes Samantha Hamilton | Licensed Psychiatric Technician | 18465 Grand Ave, Lake Elsinore, CA 92530 | 2020-08-17 |
| 1700423779 | Karrene Louise Stanard | Peer Specialist | 31764 Casino Drive, Suite 300, Lake Elsinore, CA 92530 | 2019-12-09 |
| 1972149961 | Danielle Cravalho | Student in an Organized Health Care Education/Training Program | 31964 Mission Trail, Suite B, Lake Elsinore, CA 92530 | 2019-11-25 |
| 1952825648 | R.e. Levi Dental Corporation | Dentist | 32235 Mission Trail # 8, Lake Elsinore, CA 92530 | 2017-08-03 |
| 1144760729 | Alfred Metwashla | Pharmacist | 18269 Collier Ave, Lake Elsinore, CA 92530 | 2017-03-02 |
| 1750788733 | Roxanne Martinez | Case Manager/Care Coordinator | 31764 Casino Drive, Lake Elsinore, CA 92530 | 2014-11-19 |
| 1871870907 | Bryan Tuan Tran | Pharmacist | 160 Diamond Drive, Lake Elsinore, CA 92530 | 2011-11-03 |
| 1043590821 | Katherynn Elizabeth Williams | Marriage & Family Therapist | 600 Central Ave Ste 201, Lake Elsinore, CA 92530 | 2011-08-24 |
| 1861771677 | Judy Kelly | Marriage & Family Therapist | 224 West Graham Ave, Lake Elsinore, CA 92530 | 2011-08-10 |
| 1427343813 | Patrick Chern | Pharmacist | 18287 Collier Ave., Lake Elsinore, CA 92530 | 2011-06-14 |
| Find all providers in zip 92530 | ||||
| Taxonomy Code | 261QF0400X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Federally Qualified Health Center (FQHC) |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1558925016 | Borrego Community Health Foundation | Clinic/Center | 31739 Riverside Dr Ste A1, Lake Elsinore, CA 92530-7818 | 2019-04-30 |
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|---|---|---|---|---|
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| 1134727746 | Golden Valley Health Center | Clinic/Center | 1524 Mchenry Ave Ste 565, Modesto, CA 95350-4500 | 2020-10-15 |
| 1083221451 | Harmony Health Medical Clinic and Family Resource Center | Clinic/Center | 1930 N. Beale Road, Marysville, CA 95901-6915 | 2020-09-29 |
| 1235745928 | Community Medical Centers Inc | Clinic/Center | 747 E Channel St, Stockton, CA 95202-2628 | 2020-09-18 |
| 1760098503 | Chicago Clinica Medica Familiar Operated By Neighborhood Healthcare | Clinic/Center | 4022 Chicago Ave Ste A, Riverside, CA 92507-5340 | 2020-09-17 |
| 1164037149 | Camarena Health | Clinic/Center | 16645 Road 26, Madera, CA 93638-0830 | 2020-09-15 |
| Find all providers with the same taxonomy | ||||
| City | LAKE ELSINORE |
| Zip Code | 92530 |
Please comment or provide details below to improve the information on VISTA COMMUNITY CLINIC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.