Basic Information
| Provider Information | |||||||||
| NPI: | 1083174684 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | TIBUCIO VASQUEZ HEALTH CENTER, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 22331 MISSION BLVD | ||||||||
| Address2: | |||||||||
| City: | HAYWARD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945413911 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5104715880 | ||||||||
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| Practice Location | |||||||||
| Address1: | 23640 REED WAY | ||||||||
| Address2: | |||||||||
| City: | HAYWARD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945417326 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5104715880 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/21/2019 | ||||||||
| LastUpdateDate: | 08/04/2021 | ||||||||
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| AuthorizedOfficialLastName: | SCHWAB-GALINDO | ||||||||
| AuthorizedOfficialFirstName: | ANDREA | ||||||||
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| AuthorizedOfficialTitleorPosition: | CHIEF EXECUTIVE OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 5104603855 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | TIBURCIO VASQUEZ HEALTH CENTER, INC. | ||||||||
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| NPICertificationDate: | 08/04/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QD0000X | N | Ambulatory Health Care Facilities | Clinic/Center | Dental | 261QF0400X | Y | Ambulatory Health Care Facilities | Clinic/Center | Federally Qualified Health Center (FQHC) |
No ID Information.