Healthcare Provider Details

I. General information

NPI: 1871541268
Provider Name (Legal Business Name): WEST LOS ANGELES VAMC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2006
Last Update Date: 09/24/2024
Certification Date: 09/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11301 WILSHIRE BLVD
LOS ANGELES CA
90073-1003
US

IV. Provider business mailing address

PO BOX 94424
CLEVELAND OH
44101-4424
US

V. Phone/Fax

Practice location:
  • Phone: 800-952-4852
  • Fax: 310-481-1179
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
Credential:
Phone: 202-382-2579