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General NPI Number Information
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NPI Number | 1194808840
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Entity Type | Organization
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Legal Business Name | VA LONG BEACH HEALTHCARE SYSTEM
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Dates
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Enumeration Date | 10/23/2006
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 1010 SECRETARIAT CIR
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City | COSTA MESA
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State | CA
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Zip | 92626-1620
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Country | US
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Telephone | 714-545-1858
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Fax |
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Provider Business Mailing Address
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Address Line | 1010 SECRETARIAT CIRCLE
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City | COSTA MESA
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State | CA
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Zip | 92626
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | SOCIAL WORKER
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Name | JANET DE BERRY
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Credential |
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Telephone | 562-826-8000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 273R00000X
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Taxonomy Name | Psychiatric Hospital Unit
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License Number |
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License Number State |
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