Provider Demographics
NPI:1578781043
Name:VA PALO ALTOHEALTH CARE SYSTEMS FACILITY
Entity Type:Organization
Organization Name:VA PALO ALTOHEALTH CARE SYSTEMS FACILITY
Other - Org Name:VA LIVERMORE DIVISION
Other - Org Type:Other Name
Authorized Official - Title/Position:REGISTERED DENTAL ASSISTANT
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:ELISE
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:RDA
Authorized Official - Phone:925-449-6439
Mailing Address - Street 1:1355 AUDREY DR
Mailing Address - Street 2:
Mailing Address - City:TRACY
Mailing Address - State:CA
Mailing Address - Zip Code:95376-3332
Mailing Address - Country:US
Mailing Address - Phone:209-839-8464
Mailing Address - Fax:
Practice Address - Street 1:1355 AUDREY ST
Practice Address - Street 2:
Practice Address - City:TRACY
Practice Address - State:CA
Practice Address - Zip Code:95376
Practice Address - Country:US
Practice Address - Phone:209-839-8464
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARDA1422286500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes286500000XHospitalsMilitary Hospital