NPIMap

Organization Active NPI

Vista Community Clinic

  • Federally Qualified Health Center (FQHC)
  • Oceanside, CA
National Provider Identifier
1649363375
Registry record updated Jul 25, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
License
080000510 Issued in CA
Legal business name
VISTA COMMUNITY CLINIC
Practice address
818 Pierview Way
Oceanside, CA 92054
Phone
(760) 631-5250
NPI assigned
Oct 2, 2006
Last updated
Jul 25, 2008By the provider in NPPES
Organization subpart
Yes
Parent organization
VISTA COMMUNITY CLINICAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 25, 2008

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

Authorized official

Name
Ms. Michele Lambert
Title
Cfo
Phone
(760) 726-0065

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X 080000510 CA Primary

Addresses

Primary practice location

818 Pierview Way
Oceanside, CA 92054

Mailing address

1000 Vale Terrace
Vista, CA 92084

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100720000317 CA Part A Provider - Federally Qualified Health Center (FQHC) 0042120156 Practice locations: Oceanside, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1649363375. Details of each certification follow.

Federally qualified health center certification: CCN 051950

Legal name
VISTA COMMUNITY CLINIC
Organization structure
CorporationNon-profit
Incorporated
Nov 11, 1972 in CA
Enrollment address
818 Pier View Way
Oceanside, CA 92054-2803

Other NPIs with the same Medicare PAC ID 4

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Vista Community Clinic - Horne Dispensary24 organizations share this tax ID, including this one
Part of
Vista Community Clinic - Horne Dispensary

Other organizations with this tax ID 23

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

View all 23

Locations

31361 Riverside Dr
Lake Elsinore, CA 92530
Phone (844) 308-5003

2228 Sepulveda Blvd
Torrance, CA 90501
Phone (310) 257-2598

1000 Vale Terrace Dr
Vista, CA 92084
Phone (760) 407-1220

Ownership & related parties

All disclosed owners & managing parties 18

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Star Rivera Lacey Individual Corporate DirectorBoard of Directors Jun 27, 2024
Antonio Mora Individual Corporate DirectorBoard of Directors Jan 1, 2009
Joseph Troya Individual Corporate DirectorBoard of Directors Jun 30, 2010
Fernando Sanudo Individual Corporate OfficerCeo Jan 1, 2013
W-2 Managing EmployeeCeo Jan 1, 2013
James Hagar Individual Corporate DirectorBoard of Directors Jun 30, 2010
Jennifer Irving Individual Corporate OfficerCfo Apr 6, 2026
W-2 Managing EmployeeCfo Apr 6, 2026
Mark Phillipi Individual Corporate DirectorBoard of Directors Mar 31, 2016
Mark Connelly Individual Corporate OfficerChief Growth Officer Jul 25, 2022
W-2 Managing EmployeeCgo Jul 25, 2022
Jose Aponte Individual Corporate DirectorBoard of Directors Sep 1, 2014
Quintilia Avila Individual Corporate DirectorBoard of Directors May 29, 2025
Alicia Espinoza Individual Corporate DirectorBoard of Directors Jan 26, 2023
Gerard Washington Individual Corporate DirectorBoard of Directors Aug 29, 2024
Monica Nava Individual Corporate DirectorBoard of Directors Jan 1, 2005
Scott Garrett Individual Corporate DirectorBoard of Directors Feb 27, 2025
Elisa Ayala Individual Corporate DirectorBoard of Directors Jan 26, 2023
Kwan Lee Individual Corporate DirectorBoard of Directors Jun 25, 2020
Cynthia Brazee Individual Corporate OfficerCoo Mar 4, 2025
W-2 Managing EmployeeCoo Mar 4, 2025
Angela Perez Individual Corporate DirectorBoard of Directors Jan 1, 2009

Practitioners & affiliated clinicians

Practitioners 70

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 70

NPI Registry JSON

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

{
    "created_epoch": "1159747200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1216944000000",
    "number": "1649363375",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1000 VALE TERRACE",
            "city": "VISTA",
            "state": "CA",
            "postal_code": "92084"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "818 PIERVIEW WAY",
            "city": "OCEANSIDE",
            "state": "CA",
            "postal_code": "92054",
            "telephone_number": "760-631-5250"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VISTA COMMUNITY CLINIC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "VISTA COMMUNITY CLINIC",
        "enumeration_date": "2006-10-02",
        "last_updated": "2008-07-25",
        "status": "A",
        "authorized_official_last_name": "LAMBERT",
        "authorized_official_first_name": "MICHELE",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "760-726-0065",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "CA",
            "license": "080000510",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Oceanside, CA

Sources for this page

Verify at the official NPI Registry.