Healthcare Provider Details

I. General information

NPI: 1912965658
Provider Name (Legal Business Name): LONG BEACH VAMC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2006
Last Update Date: 11/10/2020
Certification Date: 11/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

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

IV. Provider business mailing address

PO BOX 94407
CLEVELAND OH
44101-4407
US

V. Phone/Fax

Practice location:
  • Phone: 562-826-8000
  • Fax: 562-346-1742
Mailing address:
  • Phone: 702-341-3152
  • 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: ERIN DENISE POTTER
Title or Position: NPI TEAM MEMBER
Credential:
Phone: 202-382-2579