NPIMap

Organization Active NPI

Tiburcio Vasquez Health Center, Inc.

  • Federally Qualified Health Center (FQHC)
  • San Leandro, CA
National Provider Identifier
1720405491
Registry record updated Apr 4, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
TIBURCIO VASQUEZ HEALTH CENTER, INC.
Practice address
16110 E 14TH St
San Leandro, CA 94578-3002
Phone
(510) 471-5907
NPI assigned
Mar 19, 2014
Last updated
Apr 4, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 4, 2022

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

Authorized official

Name
Andrea Schwab-Galindo
Title
Chief Executive Officer
Phone
(510) 460-3855

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Community Health Clinic/Center 261QC1500X NU
Federally Qualified Health Center (FQHC) 261QF0400X NU Primary
Case Manager/Care Coordinator 171M00000X NU

Addresses

Primary practice location

16110 E 14TH St
San Leandro, CA 94578-3002

Mailing address

22331 Mission Blvd
Hayward, CA 94541-3911
Phone (510) 690-6052

Other names 1

  • San Leandro Mobile Van Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040309001428 CA Part B Supplier - Clinic/Group Practice 6608764709 Receives reassigned benefits from 28 practitioners
11 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Hayward, CA; Union City, CA; San Leandro, CA; Castro Valley, CA
O20141203002460 CA Part A Provider - Federally Qualified Health Center (FQHC) 6608764709 Practice locations: San Leandro, CA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1720405491. Details of each certification follow.

Federally qualified health center certification: CCN 751108

Legal name
TIBURCIO VASQUEZ HEALTH CENTER, INC.
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Dec 8, 2014
Last certification
Dec 8, 2014
Ownership / control type
Non-profit – church related
Organization structure
CorporationNon-profit
Incorporated
Aug 26, 1971 in CA
Enrollment address
16110 E 14TH St
San Leandro, CA 94578-3002

Other NPIs with the same Medicare PAC ID 6

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

Other NPIs on the same Medicare enrollment 10

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 9

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

NameRoleSinceShare
Jennie Reyes Individual Corporate DirectorBoard Member Feb 1, 2016
Carla Ramirez Individual Corporate DirectorBoard Member Aug 1, 2018
Jesse Robles Individual Corporate OfficerBoard Member Nov 6, 2014
Minyon Corcuchia Garde Individual Corporate DirectorBoard Member Feb 1, 2013
Andrea Schwab-Galindo Individual Corporate OfficerChief Executive Officer Jan 8, 2020
W-2 Managing EmployeeChief Executive Officer Feb 4, 2013
Josue Hernandez Individual Corporate DirectorBoard Member May 1, 2015
Monica Salgado Individual Operational/Managerial ControlExcutive Assistant Nov 6, 2014
Jaime Patino Individual Corporate OfficerBoard Member Nov 6, 2014
Nancy Soto Individual Corporate OfficerBoard Member,Board Chair Nov 6, 2014

Practitioners & affiliated clinicians

Practitioners 5

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.

NPI Registry JSON

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

{
    "created_epoch": "1395187200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1649030400000",
    "number": "1720405491",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "22331 MISSION BLVD",
            "city": "HAYWARD",
            "state": "CA",
            "postal_code": "945413911",
            "telephone_number": "510-690-6052"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16110 E 14TH ST",
            "city": "SAN LEANDRO",
            "state": "CA",
            "postal_code": "945783002",
            "telephone_number": "510-471-5907"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TIBURCIO VASQUEZ HEALTH CENTER, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-03-19",
        "last_updated": "2022-04-04",
        "certification_date": "2022-04-04",
        "status": "A",
        "authorized_official_last_name": "SCHWAB-GALINDO",
        "authorized_official_first_name": "ANDREA",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "510-460-3855"
    },
    "taxonomies": [
        {
            "code": "261QC1500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Community Health",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "San Leandro Mobile Van",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in San Leandro, CA

Sources for this page

Verify at the official NPI Registry.