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General NPI Number Information
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NPI Number | 1184807505
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Entity Type | Organization
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Legal Business Name | VA MEDICAL CENTER
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Dates
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Enumeration Date | 12/07/2007
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Last Update Date | 12/07/2007
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Provider Practice Location Address
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Address Line | 11301 WILSHIRE BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90073-1003
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Country | US
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Telephone | 310-478-3711
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Fax |
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Provider Business Mailing Address
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Address Line | 12485 WALSH AVE APT.6
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City | LOS ANGELES
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State | CA
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Zip | 90066-6666
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Country | US
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Telephone | 562-537-0823
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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 | MR. RONNEIL NINO VERGEL URRIZA
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Credential | R.N., B.S.N.
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Telephone | 562-537-0823
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 282N00000X
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Taxonomy Name | General Acute Care Hospital
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License Number | 693362
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License Number State | CA
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