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General NPI Number Information
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NPI Number | 1104149947
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Entity Type | Organization
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Legal Business Name | DEPARTMENT OF VETERAN AFFAIRS
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Dates
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Enumeration Date | 03/08/2010
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Last Update Date | 03/08/2010
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Provider Practice Location Address
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Address Line | 795 WILLOW RD (180D)
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City | MENLO PARK
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State | CA
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Zip | 94025-2539
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Country | US
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Telephone | 650-493-5000
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Fax | 650-617-6709
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Provider Business Mailing Address
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Address Line | 795 WILLOW RD (180D)
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City | MENLO PARK
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State | CA
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Zip | 94025-2539
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Country | US
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Telephone | 650-493-5000
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Fax | 650-617-6709
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Authorized Official
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Title or Position | SOCIAL WORKER CASE MANAGER
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Name | MR. GARY NOVEDA CABARDO
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Credential | ASW
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Telephone | 650-493-5000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | ASW22448
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License Number State | CA
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