Jerry L. Pettis Memorial VA Medical Center

Primary specialty

Special HospitalTaxonomy code 284300000X

License

G03312 Issued in LA

Legal business name

JERRY L. PETTIS MEMORIAL VA MEDICAL CENTER

Practice address

11201 Benton St
Loma Linda, CA 92357-1000

Phone

(909) 825-7084

NPI assigned

Dec 6, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Dean Stordahl

Title

Medical Center Director

Phone

(909) 825-7084

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1165363200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1275691594",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "116 N PLYMOUTH WAY",
            "city": "SAN BERNARDINO",
            "state": "CA",
            "postal_code": "924084116",
            "telephone_number": "909-825-7084"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11201 BENTON ST",
            "city": "LOMA LINDA",
            "state": "CA",
            "postal_code": "923571000",
            "telephone_number": "909-825-7084"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JERRY L. PETTIS MEMORIAL VA MEDICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-06",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "STORDAHL",
        "authorized_official_first_name": "DEAN",
        "authorized_official_title_or_position": "MEDICAL CENTER DIRECTOR",
        "authorized_official_telephone_number": "909-825-7084",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "284300000X",
            "taxonomy_group": "",
            "desc": "Special Hospital",
            "state": "LA",
            "license": "G03312",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ye Jin Jeon, MD
• Jennifer Jiyoon Jeong, DNP, PMHNP-BC
• Seongchan Jeong
• Vandana Jerath
• Jerry L Pettis VA Memorial Hospital
• Nicolette Jessen, MD
• Wongyun Jeung
• Victoria Francisca Jezik, RN
• Daniel Jhang, MD
• Hyein Ji, MD

• Special Hospital in Loma Linda, CA
• Providers in Loma Linda, CA by specialty
• Special Hospital in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.