Basic Information
| Provider Information | |||||||||
| NPI: | 1720654734 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SAN FRANCISCO VAMC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 94417 | ||||||||
| Address2: | |||||||||
| City: | CLEVELAND | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441014417 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7023413020 | ||||||||
| FaxNumber: | 7023413503 | ||||||||
| Practice Location | |||||||||
| Address1: | 2221 MARTIN LUTHER KING JR WAY | ||||||||
| Address2: | |||||||||
| City: | OAKLAND | ||||||||
| State: | CA | ||||||||
| PostalCode: | 946121318 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7023413020 | ||||||||
| FaxNumber: | 7023413503 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/01/2021 | ||||||||
| LastUpdateDate: | 06/01/2021 | ||||||||
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| AuthorizedOfficialLastName: | POTTER | ||||||||
| AuthorizedOfficialFirstName: | ERIN | ||||||||
| AuthorizedOfficialMiddleName: | DENISE | ||||||||
| AuthorizedOfficialTitleorPosition: | NPI TEAM MEMBER | ||||||||
| AuthorizedOfficialTelephone: | 2023822579 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 06/01/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QV0200X | Y | Ambulatory Health Care Facilities | Clinic/Center | VA |
No ID Information.