Healthcare Provider Details

I. General information

NPI: 1376887331
Provider Name (Legal Business Name): VA HEALTHCARE SYSTEM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2012
Last Update Date: 11/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3009 WAUKEGAN AVE
SIMI VALLEY CA
93063-1622
US

IV. Provider business mailing address

3009 WAUKEGAN AVE
SIMI VALLEY CA
93063-1622
US

V. Phone/Fax

Practice location:
  • Phone: 310-493-7645
  • Fax:
Mailing address:
  • Phone: 310-493-7645
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number658956
License Number StateCA

VIII. Authorized Official

Name: MRS. LESLIE AMANDA LANGLEY
Title or Position: RN
Credential: FNP
Phone: 310-478-3711