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General NPI Number Information
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NPI Number | 1245785179
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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 | 08/21/2016
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Last Update Date | 08/21/2016
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Provider Practice Location Address
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Address Line | 5939 CEDROS AVE APT A
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City | VAN NUYS
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State | CA
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Zip | 91411-3104
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Country | US
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Telephone | 310-500-0430
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Fax |
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Provider Business Mailing Address
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Address Line | 5939 CEDROS AVE APT A
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City | VAN NUYS
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State | CA
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Zip | 91411-3104
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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 | FNP-BC
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Name | MARIE MADAMBA
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Credential |
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Telephone | 310-500-0430
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 286500000X
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Taxonomy Name | Military Hospital
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License Number | 95004376
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License Number State | CA
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