Provider Demographics
NPI:1235328824
Name:VISTA HOSPITAL OF SAN GABRIEL VALLEY
Entity type:Organization
Organization Name:VISTA HOSPITAL OF SAN GABRIEL VALLEY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PT. ACCOUNT MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROSALINA
Authorized Official - Middle Name:G
Authorized Official - Last Name:MANCILLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-527-8947
Mailing Address - Street 1:14148 FRANCISQUITO AVE
Mailing Address - Street 2:
Mailing Address - City:BALDWIN PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91706-6120
Mailing Address - Country:US
Mailing Address - Phone:909-527-8947
Mailing Address - Fax:909-581-6419
Practice Address - Street 1:14148 FRANCISQUITO AVE
Practice Address - Street 2:
Practice Address - City:BALDWIN PARK
Practice Address - State:LOS ANGELES
Practice Address - Zip Code:91790
Practice Address - Country:AX
Practice Address - Phone:909-527-8947
Practice Address - Fax:909-581-6419
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-18
Last Update Date:2007-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHSP42045FMedicaid