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General NPI Number Information
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NPI Number | 1568644565
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Entity Type | Organization
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Legal Business Name | VETERANS ADMINISTRATION HOSPITAL
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Dates
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Enumeration Date | 11/30/2007
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Last Update Date | 11/30/2007
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Provider Practice Location Address
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Address Line | 3744 INGLEWOOD BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90066-3250
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Country | US
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Telephone | 310-478-3711
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Fax |
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Provider Business Mailing Address
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Address Line | 3744 INGLEWOOD BLVD
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City | MARVISTA
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State | CA
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Zip | 90066-3223
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Country | US
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Telephone | 310-478-3711
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Fax |
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Authorized Official
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Title or Position | HR
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Name | MELODY HARRIS-WOODS
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Credential |
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Telephone | 310-478-3711
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 284300000X
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Taxonomy Name | Special Hospital
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License Number | VN217335
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License Number State | CA
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