Provider Demographics
NPI:1790033397
Name:SAN FRANCISCO VA MEDICAL CENTER
Entity Type:Organization
Organization Name:SAN FRANCISCO VA MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL STAFF SPECIALIST
Authorized Official - Prefix:MS
Authorized Official - First Name:VONITA
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITE-LEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:415-221-4810
Mailing Address - Street 1:4150 CLEMENT STREET
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94121
Mailing Address - Country:US
Mailing Address - Phone:415-221-4810
Mailing Address - Fax:
Practice Address - Street 1:4150 CLEMENT STREET
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94121
Practice Address - Country:US
Practice Address - Phone:415-221-4810
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-29
Last Update Date:2012-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY25054284300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes284300000XHospitalsSpecial Hospital