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General NPI Number Information
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NPI Number | 1154583979
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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 | 07/02/2008
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Last Update Date | 07/02/2008
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Provider Practice Location Address
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Address Line | 12635 S HALO DR
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City | COMPTON
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State | CA
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Zip | 90221-1828
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Country | US
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Telephone | 310-608-1781
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Fax |
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Provider Business Mailing Address
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Address Line | 12635 S HALO DR
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City | COMPTON
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State | CA
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Zip | 90221-1828
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Country | US
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Telephone | 310-608-1781
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Fax |
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Authorized Official
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Title or Position | RECREATION THERAPIST
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Name | MR. JERMAINE LOVE WILLIAMS
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Credential |
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Telephone | 310-478-3711
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 283X00000X
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Taxonomy Name | Rehabilitation Hospital
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License Number |
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License Number State |
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