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General NPI Number Information
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NPI Number | 1235230848
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Entity Type | Organization
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Legal Business Name | VETERANS ADMINISTRATION
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Dates
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Enumeration Date | 09/26/2006
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 3315 CHANATE RD STE 1B
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City | SANTA ROSA
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State | CA
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Zip | 95404-1740
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Country | US
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Telephone | 707-570-3800
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Fax | 707-570-3860
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Provider Business Mailing Address
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Address Line | 3315 CHANATE RD STE 1B
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City | SANTA ROSA
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State | CA
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Zip | 95404-1740
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Country | US
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Telephone | 707-570-3800
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Fax | 707-570-3860
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Authorized Official
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Title or Position | STAFF PSYCHIATRIST
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Name | DR. DONALD BLAIR DEAN
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Credential | MD
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Telephone | 707-570-3800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | C19197
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License Number State | CA
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