Provider Demographics
NPI:1235230848
Name:VETERANS ADMINISTRATION
Entity Type:Organization
Organization Name:VETERANS ADMINISTRATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:STAFF PSYCHIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:BLAIR
Authorized Official - Last Name:DEAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:707-570-3800
Mailing Address - Street 1:3315 CHANATE RD STE 1B
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95404-1740
Mailing Address - Country:US
Mailing Address - Phone:707-570-3800
Mailing Address - Fax:707-570-3860
Practice Address - Street 1:3315 CHANATE RD STE 1B
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95404-1740
Practice Address - Country:US
Practice Address - Phone:707-570-3800
Practice Address - Fax:707-570-3860
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-26
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC19197261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAC19197OtherMEDICAL BOARD NUMBER
CAAD1405782OtherDEA NUMBER
CAF36134Medicare UPIN