MEDICARE: VNA OF GREATER LOS ANGELES, INC.

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	251G00000X	Community Based Hospice Care Agency		CA

General Provider Information

NPI Number	:	1528135431
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VNA OF GREATER LOS ANGELES, INC.

Provider Business Mailing Address
First Line	:	1249 S DIAMOND BAR BLVD PMB 130
Second Line	:
City	:	DIAMOND BAR
State	:	CA
Zip	:	91765-4122
Country	:	US
Telephone Number	:	310-853-1683
Fax Number	:	949-263-4762

Provider Business Practice Location Address
First Line	:	402 S PROSPECTORS RD STE G-200
Second Line	:
City	:	DIAMOND BAR
State	:	CA
Zip	:	91765-1618
Country	:	US
Telephone Number	:	310-853-1683
Fax Number	:	949-263-4762

Authorized Official
Title or Position	:	CEO
Name	:	MR. RAJNIT WALIA
Credential	:
Telephone Number	:	626-568-2588

Provider Enumeration Date	:	11/29/2006
Last Update Date	:	03/04/2024

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