Healthcare Provider Details

I. General information

NPI: 1487171096
Provider Name (Legal Business Name): SAN DIEGO VAMC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2017
Last Update Date: 09/16/2025
Certification Date: 09/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2121 SAN DIEGO AVE
SAN DIEGO CA
92110-2928
US

IV. Provider business mailing address

PO BOX 94416
CLEVELAND OH
44101-4416
US

V. Phone/Fax

Practice location:
  • Phone: 702-341-3020
  • Fax: 702-341-3503
Mailing address:
  • Phone: 702-341-3020
  • Fax: 702-341-3503

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: ERIN POTTER
Title or Position: NPI TEAM
Credential:
Phone: 202-382-2579