Healthcare Provider Details

I. General information

NPI: 1285660068
Provider Name (Legal Business Name): WEED ARMY COMMUNITY HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2031 LOVATO AVE
BARSTOW CA
92311-4719
US

IV. Provider business mailing address

2031 LOVATO AVE
BARSTOW CA
92311-4719
US

V. Phone/Fax

Practice location:
  • Phone: 760-252-3356
  • Fax:
Mailing address:
  • Phone: 760-252-3356
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code286500000X
TaxonomyMilitary Hospital
License NumberVN7272
License Number StateCA

VIII. Authorized Official

Name: MRS. CONSOLACION SALVERON REYES
Title or Position: LVN
Credential:
Phone: 760-380-6861