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General NPI Number Information
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NPI Number | 1265673032
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Entity Type | Organization
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Legal Business Name | VA LOMA LINDA HEALTH CARE SYSTEM
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Dates
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Enumeration Date | 03/09/2009
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Last Update Date | 09/01/2014
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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 | PSYCHOLOGY TECHNICIAN
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Name | MS. STEPHANIE DEANN ALTOMONTE
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Credential | MA, LPC, NCC
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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 | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number |
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License Number State |
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