Healthcare Provider Details

I. General information

NPI: 1235230848
Provider Name (Legal Business Name): VETERANS ADMINISTRATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3315 CHANATE RD STE 1B
SANTA ROSA CA
95404-1740
US

IV. Provider business mailing address

3315 CHANATE RD STE 1B
SANTA ROSA CA
95404-1740
US

V. Phone/Fax

Practice location:
  • Phone: 707-570-3800
  • Fax: 707-570-3860
Mailing address:
  • Phone: 707-570-3800
  • Fax: 707-570-3860

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License NumberC19197
License Number StateCA

VIII. Authorized Official

Name: DR. DONALD BLAIR DEAN
Title or Position: STAFF PSYCHIATRIST
Credential: MD
Phone: 707-570-3800