Healthcare Provider Details

I. General information

NPI: 1003864851
Provider Name (Legal Business Name): WEST LOS ANGELES VAMC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 04/03/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16111 PLUMMER ST
SEPULVEDA CA
91343-2036
US

IV. Provider business mailing address

PO BOX 94424
CLEVELAND OH
44101-4424
US

V. Phone/Fax

Practice location:
  • Phone: 310-268-3152
  • Fax: 310-268-4959
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