Healthcare Provider Details

I. General information

NPI: 1427326453
Provider Name (Legal Business Name): VETERANS ADMINISTRATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2011
Last Update Date: 03/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9600 VETERANS DR SW GMS-A123-HBPC
TACOMA WA
98493-0001
US

IV. Provider business mailing address

9600 VETERANS DR SW GMS-A123-HBPC
TACOMA WA
98493-0001
US

V. Phone/Fax

Practice location:
  • Phone: 253-583-1210
  • Fax:
Mailing address:
  • Phone: 253-583-1210
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QV0200X
TaxonomyVA Clinic/Center
License Number25320
License Number StateCA

VIII. Authorized Official

Name: DR. KIMBERLY E HIROTO
Title or Position: STAFF PSYCHOLOGIST
Credential: PH.D.
Phone: 253-583-1210