Provider Demographics
NPI:1578718268
Name:LONG BEACH VETERANS ADMINISTRATION MEDICAL CENTER
Entity Type:Organization
Organization Name:LONG BEACH VETERANS ADMINISTRATION MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:R.N./INTERMITTENT STAFF R.N.
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:BOLLING
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:562-826-8000
Mailing Address - Street 1:6317 SEABORN ST
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90713-2617
Mailing Address - Country:US
Mailing Address - Phone:310-291-6973
Mailing Address - Fax:562-420-6125
Practice Address - Street 1:6317 SEABORN ST
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90713-2617
Practice Address - Country:US
Practice Address - Phone:310-291-6973
Practice Address - Fax:562-420-6125
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-21
Last Update Date:2008-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA467492282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital