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General NPI Number Information
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NPI Number | 1245483171
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Entity Type | Organization
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Legal Business Name | LOMA LINDA VETERANS ADMINISTRATION
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Dates
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Enumeration Date | 10/23/2008
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Last Update Date | 10/23/2008
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Provider Practice Location Address
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Address Line | 11201 BENTON ST
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City | LOMA LINDA
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State | CA
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Zip | 92357-1000
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Country | US
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Telephone | 909-825-7084
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Fax |
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Provider Business Mailing Address
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Address Line | 11201 BENTON ST
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City | LOMA LINDA
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State | CA
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Zip | 92357-1000
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Country | US
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Telephone | 909-825-7084
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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. CHARLES A DEMOTT
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Credential |
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Telephone | 909-825-7084
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 282NC0060X
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Taxonomy Name | Critical Access Hospital
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License Number | 481489
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License Number State | CA
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