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General NPI Number Information
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NPI Number | 1952718587
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Entity Type | Organization
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Legal Business Name | VA MEDICAL CENTER
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Dates
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Enumeration Date | 07/15/2014
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Last Update Date | 07/15/2014
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Provider Practice Location Address
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Address Line | 11201 BENTON ST
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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 |
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Provider Business Mailing Address
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Address Line | 6579 HILLSIDE AVE
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City | RIVERSIDE
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State | CA
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Zip | 92504-1678
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Country | US
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Telephone | 951-785-7670
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Fax |
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Authorized Official
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Title or Position | NURSE ASSITANT
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Name | MRS. DELIA V VARA
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Credential | CNA
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Telephone | 951-785-7670
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 282E00000X
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Taxonomy Name | Long Term Care Hospital
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License Number | 00438821
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License Number State | CA
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