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General NPI Number Information
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NPI Number | 1356520779
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Entity Type | Organization
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Legal Business Name | UNKNVETERANS ADMINISTRATION
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Dates
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Enumeration Date | 11/01/2007
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Last Update Date | 11/01/2007
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Provider Practice Location Address
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Address Line | 21051 LASSEN ST APARTMENT 78
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City | CHATSWORTH
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State | CA
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Zip | 91311-4273
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Country | US
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Telephone | 319-490-9556
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Fax |
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Provider Business Mailing Address
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Address Line | 16111 PLUMMER ST
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City | SEPULVEDA
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State | CA
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Zip | 91343-2036
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Country | US
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Telephone | 818-895-9596
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Fax |
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Authorized Official
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Title or Position | DIRECTOR, COMMUNITY CARE
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Name | MR. PAUL BURTON
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Credential | MSW
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Telephone | 818-895-9596
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 261Q00000X-CLINIC/CE
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 261QF0400X
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Taxonomy Name | Federally Qualified Health Center (FQHC)
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License Number | 261QF0400X-CLINIC/CE
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 2865X1600X
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Taxonomy Name | Operational (Transportable) Military General Acute Care Hospital
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License Number | 2865X1600X-MILITARY
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License Number State | CA
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