Provider Demographics
NPI:1356520779
Name:UNKNVETERANS ADMINISTRATION
Entity type:Organization
Organization Name:UNKNVETERANS ADMINISTRATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR, COMMUNITY CARE
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:BURTON
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:818-895-9596
Mailing Address - Street 1:16111 PLUMMER ST
Mailing Address - Street 2:
Mailing Address - City:SEPULVEDA
Mailing Address - State:CA
Mailing Address - Zip Code:91343-2036
Mailing Address - Country:US
Mailing Address - Phone:818-895-9596
Mailing Address - Fax:
Practice Address - Street 1:21051 LASSEN ST
Practice Address - Street 2:APARTMENT 78
Practice Address - City:CHATSWORTH
Practice Address - State:CA
Practice Address - Zip Code:91311-4273
Practice Address - Country:US
Practice Address - Phone:319-490-9556
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-01
Last Update Date:2007-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA261Q00000X-CLINIC/CE261Q00000X
CA261QF0400X-CLINIC/CE261QF0400X
CA2865X1600X-MILITARY2865X1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2865X1600XHospitalsMilitary HospitalMilitary General Acute Care Hospital. Operational (Transportable)
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)