Basic Information
| Provider Information | |||||||||
| NPI: | 1023377868 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | VA HOSPITAL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2615 E CLINTON AVE | ||||||||
| Address2: | |||||||||
| City: | FRESNO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 937032223 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5592256100 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2615 E CLINTON AVE | ||||||||
| Address2: | |||||||||
| City: | FRESNO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 937032223 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5592256100 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/14/2012 | ||||||||
| LastUpdateDate: | 05/14/2012 | ||||||||
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| AuthorizedOfficialLastName: | SANCHEZ | ||||||||
| AuthorizedOfficialFirstName: | REMY | ||||||||
| AuthorizedOfficialMiddleName: | ANNE | ||||||||
| AuthorizedOfficialTitleorPosition: | SPEECH LANGUAGE PATHOLOGIST | ||||||||
| AuthorizedOfficialTelephone: | 5592256100 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.A.,CCC-SLP | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2865M2000X | 15072 | CA | Y | Hospitals | Military Hospital | Military General Acute Care Hospital |
No ID Information.