Organization
VISTA COMMUNITY CLINIC
Active
Other names
Vista Community Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
BARBARA MANNINO (CEO)
(760) 631-5000
Entity
Organization
Contact information
Practice address
134 GRAPEVINE RD, VISTA, CA 92083-4004
(760) 631-5030
(760) 414-3754
Mailing address
134 GRAPEVINE RD, VISTA, CA 92083-4004
(760) 631-5030
(760) 414-3754
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0002X
Clinic Pharmacy
Primary
49951
CA
3336C0003X
Community/Retail Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1851300123
—
CA
01
—
2120987
PK
—
Enumeration date
07/16/2009
Last updated
03/11/2015
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