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General NPI Number Information
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NPI Number | 1396800975
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Entity Type | Organization
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Legal Business Name | WACH
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Dates
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Enumeration Date | 12/26/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1801 E RIMROCK RD APT P21 BOX114
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City | BARSTOW
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State | CA
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Zip | 92311-5745
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Country | US
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Telephone | 661-717-8268
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Fax |
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Provider Business Mailing Address
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Address Line | 1801 E RIMROCK RD APT P21 BOX114
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City | BARSTOW
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State | CA
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Zip | 92311-5745
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Country | US
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Telephone | 661-717-8268
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Fax |
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Authorized Official
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Title or Position | LVN 68WM6
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Name | MR. LEZLIE KEITH BEARD
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Credential |
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Telephone | 760-380-2621
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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 | 207529
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License Number State | TX
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