Basic Information
| Provider Information | |||||||||
| NPI: | 1164890844 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | VETERAN'S AFFAIRS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8021 HUMMINGBIRD CIRCLE | ||||||||
| Address2: | |||||||||
| City: | LA PALMA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 90623 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5629247115 | ||||||||
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| Practice Location | |||||||||
| Address1: | 11301 WILSHIRE BLVD | ||||||||
| Address2: | |||||||||
| City: | LOS ANGLEES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 90073 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3104783711 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/11/2015 | ||||||||
| LastUpdateDate: | 09/11/2015 | ||||||||
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| AuthorizedOfficialLastName: | LONG | ||||||||
| AuthorizedOfficialFirstName: | FLORENCE | ||||||||
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| AuthorizedOfficialTitleorPosition: | SOCIAL WORK CHIEF | ||||||||
| AuthorizedOfficialTelephone: | 3104783711 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 286500000X | 11394 | PR | Y | Hospitals | Military Hospital |
No ID Information.