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General NPI Number Information
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NPI Number | 1750731154
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Entity Type | Organization
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Legal Business Name | VA GREATER LOS ANGELES HEALTH SYSTEM
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Dates
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Enumeration Date | 06/16/2016
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Last Update Date | 06/16/2016
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Provider Practice Location Address
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Address Line | 29024 DUNE LN APT 102
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City | CANYON COUNTRY
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State | CA
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Zip | 91387-5309
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Country | US
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Telephone | 818-934-3068
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Fax |
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Provider Business Mailing Address
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Address Line | 29024 DUNE LN APT 102
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City | CANYON COUNTRY
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State | CA
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Zip | 91387-5309
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Country | US
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Telephone | 818-934-3068
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Fax |
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Authorized Official
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Title or Position | LVN
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Name | BEATRIZ VENTURA ESPARZA
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Credential | LVN
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Telephone | 818-934-3068
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | VN265847
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License Number State | CA
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