NPIMap

Organization Active NPI

Long Beach Vamc

  • VA Clinic/Center
  • Gardena, CA
National Provider Identifier
1396378030
Registry record updated Feb 21, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
VA Clinic/CenterTaxonomy code 261QV0200X
Legal business name
LONG BEACH VAMC
Practice address
1149 W 190TH St Ste 100
Gardena, CA 90248-4321
Phone
(702) 341-3152
Fax
(702) 341-3503
NPI assigned
Feb 21, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 21, 2020

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

Authorized official

Name
Erin Denise Potter
Title
Npi Team Lead
Phone
(202) 382-2579

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
VA Clinic/Center 261QV0200X Primary

Addresses

Primary practice location

1149 W 190TH St Ste 100
Gardena, CA 90248-4321

Mailing address

PO Box 94407
Cleveland, OH 44101-4407
Phone (702) 341-3152

Other names 1

  • GARDENA VA CLINIC Other name

National Provider Directory

National Provider Directory
Tax ID family
Long Beach Vamc10 organizations share this tax ID, including this one

Other organizations with this tax ID 9

Organizations that report the same tax identification number in the National Provider Directory.

Locations

1149 W 190th St
Ste 100
Gardena, CA 90248

NPI Registry JSON

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

{
    "created_epoch": "1582243200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1582243200000",
    "number": "1396378030",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 94407",
            "city": "CLEVELAND",
            "state": "OH",
            "postal_code": "441014407",
            "telephone_number": "702-341-3152",
            "fax_number": "702-341-3503"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1149 W 190TH ST STE 100",
            "city": "GARDENA",
            "state": "CA",
            "postal_code": "902484321",
            "telephone_number": "702-341-3152",
            "fax_number": "702-341-3503"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LONG BEACH VAMC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-02-21",
        "last_updated": "2020-02-21",
        "certification_date": "2020-02-21",
        "status": "A",
        "authorized_official_last_name": "POTTER",
        "authorized_official_first_name": "ERIN",
        "authorized_official_middle_name": "DENISE",
        "authorized_official_title_or_position": "NPI TEAM LEAD",
        "authorized_official_telephone_number": "202-382-2579"
    },
    "taxonomies": [
        {
            "code": "261QV0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, VA",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "GARDENA VA CLINIC",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Gardena, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 21, 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.