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General NPI Number Information
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NPI Number | 1053789164
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Entity Type | Organization
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Legal Business Name | VA LONGBEACH MEDICAL CENTER
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Dates
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Enumeration Date | 09/04/2015
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Last Update Date | 09/04/2015
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Provider Practice Location Address
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Address Line | 14118 CORDARY AVE APT 22
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City | HAWTHORNE
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State | CA
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Zip | 90250-8074
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Country | US
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Telephone | 310-484-9108
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Fax |
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Provider Business Mailing Address
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Address Line | 14118 CORDARY AVE APT 22
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City | HAWTHORNE
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State | CA
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Zip | 90250-8074
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Country | US
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Telephone | 310-484-9108
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Fax |
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Authorized Official
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Title or Position | REGISTERED NURSE
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Name | APPOLLINAIRE FUNWIE
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Credential | RN
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Telephone | 310-484-9108
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 282NR1301X
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Taxonomy Name | Rural Acute Care Hospital
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License Number | 995033213
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License Number State | CA
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