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General NPI Number Information
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NPI Number | 1558315127
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Entity Type | Organization
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Legal Business Name | JAMES A. HALEY VETERANS HOSPITAL
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Dates
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Enumeration Date | 05/19/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 11707 CLUB DR
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City | TAMPA
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State | FL
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Zip | 33612-5521
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Country | US
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Telephone | 813-631-7135
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Fax | 813-631-7128
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Provider Business Mailing Address
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Address Line | 10406 N 62ND ST
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City | TAMPA
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State | FL
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Zip | 33617-3702
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Country | US
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Telephone | 813-631-7126
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Fax | 813-631-7128
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Authorized Official
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Title or Position | DDTP PSYCHIATRIST
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Name | DR. CHERYL GONZALES
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Credential | MD
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Telephone | 813-631-7126
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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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