Provider Demographics
NPI:1558470203
Name:VA HOSPITAL
Entity Type:Organization
Organization Name:VA HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED NURSE
Authorized Official - Prefix:MR
Authorized Official - First Name:SAMUSIDEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:ENIGBOKAN
Authorized Official - Suffix:
Authorized Official - Credentials:NURSING
Authorized Official - Phone:213-253-2677
Mailing Address - Street 1:3507 FLORESTA AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90043-1850
Mailing Address - Country:US
Mailing Address - Phone:323-228-9631
Mailing Address - Fax:
Practice Address - Street 1:351 E TEMPLE ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90012-3328
Practice Address - Country:US
Practice Address - Phone:213-253-2677
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health