Provider Demographics
NPI:1093981672
Name:DEPARTMENT OF VETERANS AFFAIRS
Entity Type:Organization
Organization Name:DEPARTMENT OF VETERANS AFFAIRS
Other - Org Name:MIKE O'CALLAGHAN FEDERAL HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:NURSE CLINICAL COORDINATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARIETTA
Authorized Official - Middle Name:A
Authorized Official - Last Name:CABILLO
Authorized Official - Suffix:
Authorized Official - Credentials:MSN, RN, BC
Authorized Official - Phone:702-653-3172
Mailing Address - Street 1:164 WELLSPRING AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89183-7616
Mailing Address - Country:US
Mailing Address - Phone:702-653-3172
Mailing Address - Fax:
Practice Address - Street 1:4700 NORTH LAS VEGAS BLVD.
Practice Address - Street 2:NELLIS AIR FORCE BASE
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89191-6601
Practice Address - Country:US
Practice Address - Phone:702-653-3172
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-05
Last Update Date:2008-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVRN 22304286500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes286500000XHospitalsMilitary Hospital