Basic Information
| Provider Information | |||||||||
| NPI: | 1760587562 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | VETERANS AFFAIRS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 24225 KHAN DR | ||||||||
| Address2: | |||||||||
| City: | LOMA LINDA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 923544877 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9098257084 | ||||||||
| FaxNumber: | 9097773834 | ||||||||
| Practice Location | |||||||||
| Address1: | 111201 BENTON STREET | ||||||||
| Address2: | |||||||||
| City: | LOMA LINDA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 92354 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9098257084 | ||||||||
| FaxNumber: | 9097773837 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/14/2006 | ||||||||
| LastUpdateDate: | 05/19/2022 | ||||||||
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| AuthorizedOfficialLastName: | MULTANI | ||||||||
| AuthorizedOfficialFirstName: | MALWINDER | ||||||||
| AuthorizedOfficialMiddleName: | KAUR | ||||||||
| AuthorizedOfficialTitleorPosition: | STAFF PHYSICIAN | ||||||||
| AuthorizedOfficialTelephone: | 9098257084 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | A 50535 | CA | X | Nursing & Custodial Care Facilities | Skilled Nursing Facility | 313M00000X | A50535 | CA | X | Nursing & Custodial Care Facilities | Nursing Facility/Intermediate Care Facility | 320700000X | A50535 | CA | X | Residential Treatment Facilities | Residential Treatment Facility, Physical Disabilities |
No ID Information.