Jerry L Pettis VA Memorial Hospital

Primary specialty

Psychiatric HospitalTaxonomy code 283Q00000X

Legal business name

JERRY L PETTIS VA MEMORIAL HOSPITAL

Practice address

11201 Benton St
Loma Linda, CA 92357-1000

Phone

(909) 825-7084

NPI assigned

Jul 1, 2008

Organization subpart

No

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

Authorized official

Name

Mr. Christopher Getutua Landar

Title

LVN

Phone

(909) 825-7084

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Hospital certification: CCN 05127E

Legal name

JERRY PETTIS MEM VETERANS HOSP

Certification status

Active

Provider type (POS)

Hospital

Participating since

Mar 1, 1991

Last certification

Mar 1, 1991

Facility address

11201 Benton St
Loma Linda, CA 92357

Locations

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

{
    "created_epoch": "1214870400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1214870400000",
    "number": "1871755728",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11201 BENTON ST",
            "city": "LOMA LINDA",
            "state": "CA",
            "postal_code": "923571000"
        },
        {
            "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 VA MEMORIAL HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-07-01",
        "last_updated": "2008-07-01",
        "status": "A",
        "authorized_official_last_name": "LANDAR",
        "authorized_official_first_name": "CHRISTOPHER",
        "authorized_official_middle_name": "GETUTUA",
        "authorized_official_title_or_position": "LVN",
        "authorized_official_telephone_number": "909-825-7084",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "283Q00000X",
            "taxonomy_group": "",
            "desc": "Psychiatric Hospital",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 1, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.