Provider Demographics
NPI:1982703831
Name:VA HOSPITAL SAN DIEGO
Entity Type:Organization
Organization Name:VA HOSPITAL SAN DIEGO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MHICM CASE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:RANDALL
Authorized Official - Middle Name:KEVIN
Authorized Official - Last Name:FALLS
Authorized Official - Suffix:I
Authorized Official - Credentials:RN
Authorized Official - Phone:858-552-8585
Mailing Address - Street 1:3350 LA JOLLA VILLAGE DR
Mailing Address - Street 2:
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-1806
Mailing Address - Country:US
Mailing Address - Phone:858-552-8585
Mailing Address - Fax:619-642-3119
Practice Address - Street 1:3550 LAJOLLA VILLAGE DR
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92161-0001
Practice Address - Country:US
Practice Address - Phone:858-552-8585
Practice Address - Fax:619-642-3119
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA343025251B00000X
CA343026282N00000X, 313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered251B00000XAgenciesCase Management
Not Answered282N00000XHospitalsGeneral Acute Care Hospital
Not Answered313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility