Provider Demographics
NPI:1912230939
Name:VA LOMA LINDA HEALTH CARE SYSTEM
Entity Type:Organization
Organization Name:VA LOMA LINDA HEALTH CARE SYSTEM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF AUDIOLOGY & SPEECH PATHOLOGY
Authorized Official - Prefix:DR
Authorized Official - First Name:VICKI
Authorized Official - Middle Name:
Authorized Official - Last Name:BRADLEY
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:909-825-7084
Mailing Address - Street 1:22990 ORANGEWOOD CT
Mailing Address - Street 2:
Mailing Address - City:GRAND TERRACE
Mailing Address - State:CA
Mailing Address - Zip Code:92313-5549
Mailing Address - Country:US
Mailing Address - Phone:909-825-7084
Mailing Address - Fax:909-777-3854
Practice Address - Street 1:11201 BENTON ST
Practice Address - Street 2:RM#3A-25
Practice Address - City:LOMA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92357-1000
Practice Address - Country:US
Practice Address - Phone:909-825-7084
Practice Address - Fax:909-777-3854
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-09
Last Update Date:2009-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12843282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital