Healthcare Provider Details

I. General information

NPI: 1700209715
Provider Name (Legal Business Name): VA LOMA LINDA HEALTHCARE SYSTEM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/27/2014
Last Update Date: 01/27/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4381 E OAK HILL DR
ANAHEIM CA
92807-3503
US

IV. Provider business mailing address

4381 E OAK HILL DR
ANAHEIM CA
92807-3503
US

V. Phone/Fax

Practice location:
  • Phone: 808-398-4629
  • Fax:
Mailing address:
  • Phone: 808-398-4629
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number3853
License Number StateHI

VIII. Authorized Official

Name: MS. NANCY ANN MCNAMARA
Title or Position: LICENSED CLINICAL SOCIAL WORKER
Credential: LCSW
Phone: 808-398-4629