1285982959 NPI number — U.S. DEPARTMENT OF VETERANS AFFAIRS

Table of content: (NPI 1285982959)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285982959 NPI number — U.S. DEPARTMENT OF VETERANS AFFAIRS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
U.S. DEPARTMENT OF VETERANS AFFAIRS
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
VETERANS HEALTH ADMINISTRATION
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1285982959
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/28/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5901 E 7TH ST
Provider Second Line Business Mailing Address:
BLDG 128 RM K133A MAIL CODE 116A
Provider Business Mailing Address City Name:
LONG BEACH
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90822-5201
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
562-826-8000
Provider Business Mailing Address Fax Number:
818-302-3700

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5901 E 7TH ST
Provider Second Line Business Practice Location Address:
BLDG 128 RM K133A MAIL CODE 116A
Provider Business Practice Location Address City Name:
LONG BEACH
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90822-5201
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-826-8000
Provider Business Practice Location Address Fax Number:
818-302-3700
Provider Enumeration Date:
08/28/2012

Additional Information

Authorized Official

Authorized Official Last Name:
CREY
Authorized Official First Name:
KEVIN
Authorized Official Middle Name:
SCOTT
Authorized Official Title or Position:
PROGRAM SPECIALIST/
Authorized Official Telephone Number:
562-826-8000

Provider Taxonomy Codes

  • Taxonomy code: 343900000X , with the licence number:  N5520601 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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