Healthcare Provider Details

I. General information

NPI: 1164890844
Provider Name (Legal Business Name): VETERAN'S AFFAIRS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2015
Last Update Date: 09/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11301 WILSHIRE BLVD
LOS ANGLEES CA
90073
US

IV. Provider business mailing address

8021 HUMMINGBIRD CIRCLE
LA PALMA CA
90623
US

V. Phone/Fax

Practice location:
  • Phone: 310-478-3711
  • Fax:
Mailing address:
  • Phone: 562-924-7115
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code286500000X
TaxonomyMilitary Hospital
License Number11394
License Number StatePR

VIII. Authorized Official

Name: FLORENCE LONG
Title or Position: SOCIAL WORK CHIEF
Credential:
Phone: 310-478-3711