Healthcare Provider Details

I. General information

NPI: 1215124896
Provider Name (Legal Business Name): VA MANILA OUTPATIENT CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2007
Last Update Date: 09/28/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2201 ROXA BLVD
PASAY CITY PHILILIPPINES
1300
PH

IV. Provider business mailing address

2201 ROXA BLVD
PASAY CITY PHILILIPPINES
1300
PH

V. Phone/Fax

Practice location:
  • Phone: 0116328334566
  • Fax:
Mailing address:
  • Phone: 0116328334566
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QV0200X
TaxonomyVA Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: BARBARA MAYERICK
Title or Position: DIRECTOR, BUSINESS DEVELOPMENT
Credential:
Phone: 202-254-0339