Healthcare Provider Details

I. General information

NPI: 1730234493
Provider Name (Legal Business Name): VETERANS HOME OF CALIFORNIA-CHULA VISTA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2007
Last Update Date: 05/01/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 E NAPLES CT
CHULA VISTA CA
91911-6821
US

IV. Provider business mailing address

700 E NAPLES CT
CHULA VISTA CA
91911-6821
US

V. Phone/Fax

Practice location:
  • Phone: 619-482-6020
  • Fax: 619-205-1905
Mailing address:
  • Phone: 619-482-6020
  • Fax: 619-205-1905

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License NumberPHE44723
License Number StateCA

VIII. Authorized Official

Name: HARRIETTE BANNISTER
Title or Position: DIRECTOR OF PHARMACY
Credential: BSP
Phone: 619-482-6020