Vista Psychiatric and Primary Care Services

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

Legal business name

VISTA PSYCHIATRIC AND PRIMARY CARE SERVICES

Practice address

2288 Fulton St
Suite 309
Berkeley, CA 94704-1493

Phone

(510) 517-3156

NPI assigned

Apr 26, 2016

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Yonis A Mudey, DNPNPI 1790048767

Title

Ceo

Phone

(510) 517-3156

Specialties & licenses 6

Addresses

Other names 1

• Vista Psychiatric and Primary Care Services Doing business as

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Yonis A Mudey, NURSE PRACTITIONER

  • Psychiatric/Mental Health Nurse Practitioner
  • Berkeley, CA
  • NPI 1790048767
  Medicare reassignment Care Compare group Authorized official
• Scion Canlas Mangubat, NP-C

  • Psychiatric/Mental Health Nurse Practitioner
  • San Francisco, CA
  • NPI 1851656946
  Medicare reassignment Care Compare group

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1461628800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1726444800000",
    "number": "1023463189",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "448 IGNACIO BLVD",
            "city": "NOVATO",
            "state": "CA",
            "postal_code": "949496085"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2288 FULTON ST",
            "address_2": "SUITE 309",
            "city": "BERKELEY",
            "state": "CA",
            "postal_code": "947041493",
            "telephone_number": "510-517-3156"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VISTA PSYCHIATRIC AND PRIMARY CARE SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-04-26",
        "last_updated": "2024-09-16",
        "certification_date": "2024-09-16",
        "status": "A",
        "authorized_official_last_name": "MUDEY",
        "authorized_official_first_name": "YONIS",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "510-517-3156",
        "authorized_official_credential": "DNP"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363LA2200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Adult Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LC1500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Community Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LP2300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Primary Care",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Vista Psychiatric and Primary Care Services",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Vista Psychiatric and Primary Care Services",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Nurse Practitioner in Berkeley, CA
• Providers in Berkeley, CA by specialty
• Nurse Practitioner in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 16, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.