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General NPI Number Information
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NPI Number | 1912230939
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Entity Type | Organization
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Legal Business Name | VA LOMA LINDA HEALTH CARE SYSTEM
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Dates
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Enumeration Date | 09/09/2009
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Last Update Date | 09/09/2009
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Provider Practice Location Address
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Address Line | 11201 BENTON ST RM#3A-25
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City | LOMA LINDA
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State | CA
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Zip | 92357-1000
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Country | US
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Telephone | 909-825-7084
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Fax | 909-777-3854
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Provider Business Mailing Address
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Address Line | 22990 ORANGEWOOD CT
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City | GRAND TERRACE
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State | CA
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Zip | 92313-5549
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Country | US
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Telephone | 909-825-7084
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Fax | 909-777-3854
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Authorized Official
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Title or Position | CHIEF AUDIOLOGY & SPEECH PATHOLOGY
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Name | DR. VICKI BRADLEY
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Credential | AUD
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Telephone | 909-825-7084
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 282N00000X
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Taxonomy Name | General Acute Care Hospital
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License Number | 12843
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License Number State | CA
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