Basic Information
| Provider Information | |||||||||
| NPI: | 1871686550 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | VETERANS AFFAIRS HEALTHCARE SYSTEM | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8839 ORCHARD AVE | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 90044 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3239711338 | ||||||||
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| Practice Location | |||||||||
| Address1: | 11301 WILSHIRE BLVD | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 90073 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3104783711 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/02/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | SIMON | ||||||||
| AuthorizedOfficialFirstName: | CHANDA | ||||||||
| AuthorizedOfficialMiddleName: | NICOLE | ||||||||
| AuthorizedOfficialTitleorPosition: | REGISTERED KINESIOTHERAPIST | ||||||||
| AuthorizedOfficialTelephone: | 3234783711 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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| AuthorizedOfficialCredential: | MHA, RKT | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 286500000X | 1672 | CA | Y | Hospitals | Military Hospital |
No ID Information.