Provider Demographics
NPI:1285744326
Name:SAN DIEGO VA HEALTHCARE SYSTEM
Entity type:Organization
Organization Name:SAN DIEGO VA HEALTHCARE SYSTEM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSSIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:858-552-8585
Mailing Address - Street 1:3350 LA JOLLA VILLAGE DR
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92161-0002
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3350 LA JOLLA VILLAGE DR
Practice Address - Street 2:
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-1806
Practice Address - Country:US
Practice Address - Phone:858-552-8585
Practice Address - Fax:858-552-4315
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA189407261QR0400X, 283X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Not Answered283X00000XHospitalsRehabilitation Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA468OtherCNS CERTICATE
CA189407OtherRN LICENSE