Basic Information
| Provider Information | |||||||||
| NPI: | 1114050309 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | VA WLA HEALTHCARE CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11301 WILSHIRE BLVD | ||||||||
| Address2: | 116AR BLDG 208 RM 129 | ||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900731003 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3104783711 | ||||||||
| FaxNumber: | 3102684781 | ||||||||
| Practice Location | |||||||||
| Address1: | 11301 WILSHIRE BLVD | ||||||||
| Address2: | 116AR BLDG 208 RM 129 | ||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900731003 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3104783711 | ||||||||
| FaxNumber: | 3102684781 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/14/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | STEIN | ||||||||
| AuthorizedOfficialFirstName: | CAROL | ||||||||
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| AuthorizedOfficialTitleorPosition: | CHIEF OCCUPATIONAL THERAPIST | ||||||||
| AuthorizedOfficialTelephone: | 3104783711 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | OTR | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 284300000X | 6452 | CA | Y | Hospitals | Special Hospital |
No ID Information.