MEDICARE: VETERAN'S AFFAIRS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	286500000X	Military Hospital	11394	PR

General Provider Information

NPI Number	:	1164890844
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VETERAN'S AFFAIRS

Provider Business Mailing Address
First Line	:	8021 HUMMINGBIRD CIRCLE
Second Line	:
City	:	LA PALMA
State	:	CA
Zip	:	90623
Country	:	US
Telephone Number	:	562-924-7115
Fax Number	:

Provider Business Practice Location Address
First Line	:	11301 WILSHIRE BLVD
Second Line	:
City	:	LOS ANGLEES
State	:	CA
Zip	:	90073
Country	:	US
Telephone Number	:	310-478-3711
Fax Number	:

Authorized Official
Title or Position	:	SOCIAL WORK CHIEF
Name	:	FLORENCE LONG
Credential	:
Telephone Number	:	310-478-3711

Provider Enumeration Date	:	09/11/2015
Last Update Date	:	09/11/2015

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1609243534 — U.S. DEPARTMENT OF VETERAN'S AFFAIRS
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