Healthcare Provider Details

I. General information

NPI: 1598713703
Provider Name (Legal Business Name): MARTINEZ VAMC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 04/16/2024
Certification Date: 04/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 CONCORD AVE
CHICO CA
95928-9487
US

IV. Provider business mailing address

PO BOX 94412
CLEVELAND OH
44101-4412
US

V. Phone/Fax

Practice location:
  • Phone: 530-879-5054
  • Fax: 530-879-5040
Mailing address:
  • Phone: 702-341-3020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332100000X
TaxonomyDepartment of Veterans Affairs (VA) Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MS. ERIN POTTER
Title or Position: NPI TEAM
Credential:
Phone: 202-382-2579