Provider Demographics
NPI:1568644565
Name:VETERANS ADMINISTRATION HOSPITAL
Entity Type:Organization
Organization Name:VETERANS ADMINISTRATION HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HR
Authorized Official - Prefix:
Authorized Official - First Name:MELODY
Authorized Official - Middle Name:
Authorized Official - Last Name:HARRIS-WOODS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-478-3711
Mailing Address - Street 1:3744 INGLEWOOD BLVD
Mailing Address - Street 2:
Mailing Address - City:MARVISTA
Mailing Address - State:CA
Mailing Address - Zip Code:90066-3223
Mailing Address - Country:US
Mailing Address - Phone:310-478-3711
Mailing Address - Fax:
Practice Address - Street 1:3744 INGLEWOOD BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90066-3250
Practice Address - Country:US
Practice Address - Phone:310-478-3711
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-30
Last Update Date:2007-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN217335284300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes284300000XHospitalsSpecial Hospital