Provider Demographics
NPI:1255698288
Name:VETERANS ADMINISTRATION
Entity type:Organization
Organization Name:VETERANS ADMINISTRATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OOQ
Authorized Official - Prefix:
Authorized Official - First Name:JOSIE
Authorized Official - Middle Name:
Authorized Official - Last Name:SISON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:415-221-4810
Mailing Address - Street 1:7 LAVENHAM ROAD
Mailing Address - Street 2:
Mailing Address - City:NOVATO
Mailing Address - State:CA
Mailing Address - Zip Code:94949
Mailing Address - Country:US
Mailing Address - Phone:415-218-1435
Mailing Address - Fax:
Practice Address - Street 1:7 LAVENHAM RD
Practice Address - Street 2:
Practice Address - City:NOVATO
Practice Address - State:CA
Practice Address - Zip Code:94949-6296
Practice Address - Country:US
Practice Address - Phone:415-218-1435
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-16
Last Update Date:2012-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care