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General NPI Number Information
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NPI Number | 1992956189
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Entity Type | Organization
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Legal Business Name | VA GREATER LOS ANGELES HEALTHCARE SYSTEM
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Dates
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Enumeration Date | 10/06/2008
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Last Update Date | 10/06/2008
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Provider Practice Location Address
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Address Line | 13603 S MARIPOSA AVE
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City | GARDENA
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State | CA
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Zip | 90247-2005
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Country | US
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Telephone | 310-719-7187
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Fax |
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Provider Business Mailing Address
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Address Line | 13603 S MARIPOSA AVE
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City | GARDENA
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State | CA
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Zip | 90247-2005
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Country | US
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Telephone | 310-719-7187
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Fax |
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Authorized Official
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Title or Position | NURSE MANAGER O/P MENTAL HEALTH
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Name | MRS. HELEN BONANOMI
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Credential | MSN, RN, CARN
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Telephone | 310-471-3711
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | RN306586
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License Number State | CA
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