Provider Demographics
NPI:1114351517
Name:VA PUGET SOUND HCS, AMERICAN LAKE DIVISION
Entity Type:Organization
Organization Name:VA PUGET SOUND HCS, AMERICAN LAKE DIVISION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:STAFF PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ZEBA
Authorized Official - Middle Name:
Authorized Official - Last Name:AHMAD
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:253-583-1139
Mailing Address - Street 1:9600 VETERANS DR SW
Mailing Address - Street 2:A-116-ATC
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98493-0001
Mailing Address - Country:US
Mailing Address - Phone:253-583-1139
Mailing Address - Fax:253-589-4167
Practice Address - Street 1:9600 VETERANS DR SW
Practice Address - Street 2:A-116-ATC
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98493-0001
Practice Address - Country:US
Practice Address - Phone:253-583-1139
Practice Address - Fax:253-589-4167
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-21
Last Update Date:2013-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY 60259411286500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes286500000XHospitalsMilitary Hospital