| Canyon Vista Healthcare Medical Corporation | |
|
2319 E Washington Blvd Suite One Pasadena CA 91104-1945 | |
| (626) 296-3181 | |
| Not Available |
| Full Name | Canyon Vista Healthcare Medical Corporation |
|---|---|
| Speciality | Clinic/Center |
| Location | 2319 E Washington Blvd, Pasadena, California |
| Authorized Official Name and Position | William D Mcintyre (PRESIDENT) |
| Authorized Official Contact | 6262963181 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Canyon Vista Healthcare Medical Corporation 2319 E Washington Blvd Suite One Pasadena CA 91104-1945 Ph: (626) 296-3181 | Canyon Vista Healthcare Medical Corporation 2319 E Washington Blvd Suite One Pasadena CA 91104-1945 Ph: (626) 296-3181 |
| NPI Number | 1245526029 |
|---|---|
| Provider Enumeration Date | 06/21/2011 |
| Last Update Date | 06/21/2011 |
| Medicare PECOS PAC ID | 5092984450 |
|---|---|
| Medicare Enrollment ID | O20110802000172 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1245526029 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | G29828 (California) | Primary |
| Provider Name | William D Mcintyre |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1710925144 PECOS PAC ID: 8527237981 Enrollment ID: I20110802000198 |
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