NPIMap

Organization Active NPI

Vista Community Clinic

  • Clinic Pharmacy
  • Vista, CA
National Provider Identifier
1619107240
Registry record updated Mar 11, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic PharmacyTaxonomy code 3336C0002X
License
49951 Issued in CA
Legal business name
VISTA COMMUNITY CLINIC
Doing business as
Vista Community Clinic
Practice address
134 Grapevine Rd
Vista, CA 92083-4004
Phone
(760) 631-5030
Fax
(760) 414-3754
NPI assigned
Jul 16, 2009
Last updated
Mar 11, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 11, 2015

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

Authorized official

Name
Barbara Mannino
Title
Ceo
Phone
(760) 631-5000

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X NU
Clinic Pharmacy 3336C0002X 49951 CA Primary
Community/Retail Pharmacy 3336C0003X NU

Addresses

Primary practice location

134 Grapevine Rd
Vista, CA 92083-4004

Mailing address

134 Grapevine Rd
Vista, CA 92083-4004
Phone (760) 631-5030

Other identifiers 2

IdentifierTypeStateIssuer
1851300123MedicaidCA
2120987OtherPK

Other names 1

  • Vista Community Clinic Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Vista Community Clinic - Dental24 organizations share this tax ID, including this one

Other organizations with this tax ID 23

Organizations that report the same tax identification number in the National Provider Directory.

View all 23

NPI Registry JSON

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

{
    "created_epoch": "1247702400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1426032000000",
    "number": "1619107240",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "134 GRAPEVINE RD",
            "city": "VISTA",
            "state": "CA",
            "postal_code": "920834004",
            "telephone_number": "760-631-5030",
            "fax_number": "760-414-3754"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "134 GRAPEVINE RD",
            "city": "VISTA",
            "state": "CA",
            "postal_code": "920834004",
            "telephone_number": "760-631-5030",
            "fax_number": "760-414-3754"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VISTA COMMUNITY CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-07-16",
        "last_updated": "2015-03-11",
        "status": "A",
        "authorized_official_last_name": "MANNINO",
        "authorized_official_first_name": "BARBARA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "760-631-5000"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0002X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Clinic Pharmacy",
            "state": "CA",
            "license": "49951",
            "primary": true
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1851300123",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2120987",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Vista Community Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Vista, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 11, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.