Basic Information
| Provider Information | |||||||||
| NPI: | 1568644565 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | VETERANS ADMINISTRATION HOSPITAL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3744 INGLEWOOD BLVD | ||||||||
| Address2: | |||||||||
| City: | MARVISTA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900663223 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3104783711 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3744 INGLEWOOD BLVD | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900663250 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3104783711 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/30/2007 | ||||||||
| LastUpdateDate: | 11/30/2007 | ||||||||
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| AuthorizedOfficialLastName: | HARRIS-WOODS | ||||||||
| AuthorizedOfficialFirstName: | MELODY | ||||||||
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| AuthorizedOfficialTitleorPosition: | HR | ||||||||
| AuthorizedOfficialTelephone: | 3104783711 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 284300000X | VN217335 | CA | Y | Hospitals | Special Hospital |
No ID Information.