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General NPI Number Information
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NPI Number | 1154631158
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Entity Type | Organization
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Legal Business Name | TRIOVERSEAS VETERANS HEATHCARE PROVIDER
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Dates
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Enumeration Date | 10/10/2010
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Last Update Date | 10/10/2010
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Provider Practice Location Address
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Address Line | TRI OVERSEAS VETERANS HEALTH CARE PROVIDER RM, 504 PHYSICIANS CENTER, DR. R. POTENCIANO
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City | MANDALUYONG CITY
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State | 163 EPIFANIO DELOS SANTOS AVE.
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Zip | 1550
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Country | PH
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Telephone | 927-650-0014
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Fax |
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Provider Business Mailing Address
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Address Line | TRI OVERSEAS VETERANS HEALTH CARE PROVIDER RM, 504 PHYSICIANS CENTER, DR. R. POTENCIANO
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City | MANDALUYONG CITY
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State | 163 EPIFANIO DELOS SANTOS AVE.
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Zip | 1550
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Country | PH
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Telephone | 927-650-0014
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Fax |
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Authorized Official
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Title or Position | NURSE-BILLER
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Name | MS. RESENA MAYUGA BANTANG
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Credential |
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Telephone | 927-650-0014
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number |
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License Number State |
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