Healthcare Provider Details

I. General information

NPI: 1336412303
Provider Name (Legal Business Name): LONG BEACH VA MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2012
Last Update Date: 02/21/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5901 E 7TH ST A 130
LONG BEACH CA
90822-5201
US

IV. Provider business mailing address

5901 E 7TH ST
LONG BEACH CA
90822-5201
US

V. Phone/Fax

Practice location:
  • Phone: 562-826-8000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code284300000X
TaxonomySpecial Hospital
License Number5388
License Number StateTN

VIII. Authorized Official

Name: AMI MAE FLOURNOY
Title or Position: SOCIAL WORKER CASE MANAGER
Credential:
Phone: 562-243-3709