=====================================================
General NPI Number Information
=====================================================
NPI Number | 1487171096
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SAN DIEGO VAMC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/24/2017
-----------------------------------------------------
Last Update Date | 09/16/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2121 SAN DIEGO AVE
-----------------------------------------------------
City | SAN DIEGO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92110-2928
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 702-341-3020
-----------------------------------------------------
Fax | 702-341-3503
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 94416
-----------------------------------------------------
City | CLEVELAND
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44101-4416
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 702-341-3020
-----------------------------------------------------
Fax | 702-341-3503
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | NPI TEAM
-----------------------------------------------------
Name | ERIN POTTER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 202-382-2579
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 323P00000X
-----------------------------------------------------
Taxonomy Name | Psychiatric Residential Treatment Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------