Provider Demographics
NPI:1437387453
Name:LONG BEACH VA
Entity Type:Organization
Organization Name:LONG BEACH VA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:STUDENT
Authorized Official - Prefix:
Authorized Official - First Name:AMAL
Authorized Official - Middle Name:
Authorized Official - Last Name:GERGIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-456-7002
Mailing Address - Street 1:800 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92701-3576
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:800 N MAIN ST
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92701-3576
Practice Address - Country:US
Practice Address - Phone:562-826-8000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-29
Last Update Date:2009-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes286500000XHospitalsMilitary Hospital