Organization
VISTA COMMUNITY CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
FERNANDO SANUDO (CEO)
(760) 631-5000
Entity
Organization
Contact information
Practice address
30195 FRASER DR, LAKE ELSINORE, CA 92530-7006
(760) 631-5000
Mailing address
1000 VALE TERRACE DR, VISTA, CA 92084-5218
(760) 631-5000
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Enumeration date
02/26/2015
Last updated
02/10/2016
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