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General NPI Number Information
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NPI Number | 1609243534
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Entity Type | Organization
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Legal Business Name | U.S. DEPARTMENT OF VETERAN'S AFFAIRS
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Dates
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Enumeration Date | 08/26/2015
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Last Update Date | 08/26/2015
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Provider Practice Location Address
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Address Line | 11301 WILSHIRE BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90073-1003
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Country | US
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Telephone | 310-405-5872
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Fax |
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Provider Business Mailing Address
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Address Line | 11301 WILSHIRE BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90073-1003
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | SOCIAL WORKER
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Name | CARI MAY CLARK
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Credential | MSW
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Telephone | 310-405-5872
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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 | ASW28982
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License Number State | CA
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