Healthcare Provider Details

I. General information

NPI: 1174766687
Provider Name (Legal Business Name): VETRERAN AFFAIRS ADMINISTRATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/14/2009
Last Update Date: 04/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 LOCUST STREET
RENO NV
89520
US

IV. Provider business mailing address

1233 HUMBOLDT ST
RENO NV
89509-2731
US

V. Phone/Fax

Practice location:
  • Phone: 775-786-7200
  • Fax:
Mailing address:
  • Phone: 775-232-2498
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License NumberRN53257
License Number StateNV

VIII. Authorized Official

Name: JUDITH LOPEZ
Title or Position: MANAGER EMERGENCY DEPARTMENT
Credential:
Phone: 775-328-1219