Basic Information
| Provider Information | |||||||||
| NPI: | 1285090944 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | VA LONG BEACH HEALTHCARE SYSTEM | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5901 E 7TH ST # 07128 | ||||||||
| Address2: | SPINAL CORD INJURY HEALTHCARE GROUP | ||||||||
| City: | LONG BEACH | ||||||||
| State: | CA | ||||||||
| PostalCode: | 908225201 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5628268000 | ||||||||
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| Practice Location | |||||||||
| Address1: | 5901 E 7TH ST # 07128 | ||||||||
| Address2: | SPINAL CORD INJURY HEALTHCARE GROUP | ||||||||
| City: | LONG BEACH | ||||||||
| State: | CA | ||||||||
| PostalCode: | 908225201 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5628268000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/11/2016 | ||||||||
| LastUpdateDate: | 01/11/2016 | ||||||||
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| AuthorizedOfficialLastName: | SMITH | ||||||||
| AuthorizedOfficialFirstName: | LATOYA | ||||||||
| AuthorizedOfficialMiddleName: | ELAINE | ||||||||
| AuthorizedOfficialTitleorPosition: | CLINICAL NURSE SPECIALIST | ||||||||
| AuthorizedOfficialTelephone: | 5628268000 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | RN, CNS | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | 4120 | CA | Y | Hospitals | General Acute Care Hospital |
No ID Information.