Healthcare Provider Details

I. General information

NPI: 1366797334
Provider Name (Legal Business Name): DEPARTAMENT OF VETERANS AFFAIRS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2012
Last Update Date: 07/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 EAST INDIAN SCHOOL ROAD
PHOENIX AZ
85012-1892
US

IV. Provider business mailing address

650 E INDIAN SCHOOL RD
PHOENIX AZ
85012-1839
US

V. Phone/Fax

Practice location:
  • Phone: 602-277-5551
  • Fax:
Mailing address:
  • Phone: 602-277-5551
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code286500000X
TaxonomyMilitary Hospital
License NumberCRT#13852
License Number StateAZ

VIII. Authorized Official

Name: MRS. FLORENTINA DANIELA LIPAN
Title or Position: TECHNOLOGIST
Credential: MRI/CT
Phone: 602-277-5551