Healthcare Provider Details

I. General information

NPI: 1023377868
Provider Name (Legal Business Name): VA HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2012
Last Update Date: 05/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2615 E CLINTON AVE
FRESNO CA
93703-2223
US

IV. Provider business mailing address

2615 E CLINTON AVE
FRESNO CA
93703-2223
US

V. Phone/Fax

Practice location:
  • Phone: 559-225-6100
  • Fax:
Mailing address:
  • Phone: 559-225-6100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2865M2000X
TaxonomyMilitary General Acute Care Hospital
License Number15072
License Number StateCA

VIII. Authorized Official

Name: REMY ANNE SANCHEZ
Title or Position: SPEECH LANGUAGE PATHOLOGIST
Credential: M.A.,CCC-SLP
Phone: 559-225-6100