JERRY L. PETTIS MEMORIAL VA MEDICAL CENTER (NPI# 1275691594) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1275691594 |
| Entity Type | Organization |
| Organization Name | JERRY L. PETTIS MEMORIAL VA MEDICAL CENTER |
| Practice Address |
11201 Benton St Loma Linda CA 92357-1000 |
| Mailing Address |
116 N Plymouth Way San Bernardino CA 92408-4116 |
| Practice Telephone | 9098257084 |
| Mailing Telephone | 9098257084 |
| Enumeration Date | 2006-12-06 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | MR. DEAN STORDAHL (MEDICAL CENTER DIRECTOR) |
| Authorized Official Telephone | 9098257084 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 284300000X | Special Hospital | G03312 | LA | Hospitals |
| Street Address |
11201 BENTON ST |
| City | LOMA LINDA |
| State | CA |
| Zip Code | 92357-1000 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1841290558 | Russell Evan Hoxie Jr. | Internal Medicine | 11201 Benton St, Loma Linda, CA 92357-1000 | 2005-07-22 |
| 1104435643 | Megan Satre | Audiologist | 11201 Benton St, Loma Linda, CA 92357-1000 | 2020-07-30 |
| 1972111862 | Aileen Nati Ludesirishoti | Pharmacist | 11201 Benton St, Loma Linda, CA 92357-1000 | 2020-07-17 |
| 1649894551 | Bryan Lamont Brewer | Social Worker | 11201 Benton St, Loma Linda, CA 92357-1000 | 2020-06-05 |
| 1518580497 | Nicole Kaye Whittle | Audiologist | 11201 Benton St, Loma Linda, CA 92357-1000 | 2020-05-26 |
| 1629690375 | Kevin Alan Cox | Student in an Organized Health Care Education/Training Program | 11201 Benton St, Loma Linda, CA 92357-1000 | 2020-05-15 |
| 1033731443 | Joni Lynn Stanton | Registered Nurse | 11201 Benton St, Loma Linda, CA 92357-1000 | 2020-05-08 |
| 1134748536 | Abednego Tamba | Registered Nurse | 11201 Benton St, Loma Linda, CA 92357-1000 | 2020-04-15 |
| 1447885884 | Zachary Michael Cruz | Registered Nurse | 11201 Benton St, Loma Linda, CA 92357-1000 | 2020-03-05 |
| 1972141695 | Tanya Lengvilas | Pharmacist | 11201 Benton St, Loma Linda, CA 92357-1000 | 2019-12-12 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679916027 | Nicole Kristine Shah-ghassemzadeh | Internal Medicine | Jerry L. Pettis Memorial Veterans Hospital - Gastroente, 11201 Benton Street, Loma Linda, CA 92357 | 2013-04-16 |
| 1760628598 | Taranjit Natt | Internal Medicine | 11201 Benton St # 111-om, Loma Linda, CA 92357 | 2008-12-29 |
| 1548355076 | Annette A Boyd -hampton | Nurse Practitioner | 11201 Benton St. -111g, Loma Linda, CA 92357 | 2006-10-03 |
| 1396830766 | Maudie Cantrell Foy | Nurse Practitioner | 11201 Benton St. (11cp), Loma Linda, CA 92357 | 2006-10-03 |
| 1427154715 | Kenneth Wong | Pharmacist | 11201 Benton St. (119), Loma Linda, CA 92357 | 2006-09-15 |
| 1801909577 | Paul Lindberg | Orthotist | 11201 Benton St./121, Loma Linda, CA 92357 | 2006-08-16 |
| 1992728703 | Harry Chen | Pharmacist | 11201 Benton Street, Va Loma Linda Healthcare System (119), Loma Linda, CA 92357 | 2006-07-25 |
| 1699222661 | Nathanial Benjaman Hawkins | Psychologist | 11201 Benton Street, Bhost 116a, Loma Linda, CA 92357 | 2016-09-07 |
| 1063877959 | Irene Thung | Pathology | 11201 Benton Street, Dept. of Pathology (113), Loma Linda, CA 92357 | 2015-12-21 |
| 1033553375 | Brian Chau | Physical Medicine & Rehabilitation | 11201 Benton Street, Department of Pm&r (mail Code 117), Loma Linda, CA 92357 | 2013-04-17 |
| Find all providers in zip 92357 | ||||
| Taxonomy Code | 284300000X |
| Grouping | Hospitals |
| Classification | Special Hospital |
| A designation by the AHA of a hospital whose primary function of the institution is to provide diagnostic and treatment services for patients who have specified medical conditions, both surgical and nonsurgical. |
| Notes: Source: AHA Guide, Registration section, p. A5. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1760774947 | Loma Linda University | Special Hospital | 1234 Anderson Street, Gme Office Csp 21005, Loma Linda, CA 92350 | 2011-05-06 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1053857706 | 5 Direction Integrative Veterinary Care | Special Hospital | 32 Ulloa St, San Francisco, CA 94127-1218 | 2017-01-18 |
| 1770032690 | Astghik Harutyunyan | Special Hospital | 3699 Wilshire Blve, Los Angeles, CA 90010 | 2016-10-04 |
| 1821458662 | Poodles Inc | Special Hospital | 1333 9th Ave, San Francisco, CA 94122-2308 | 2016-03-04 |
| 1588023824 | Sue K Morizi | Special Hospital | 7527 Draper Ave, La Jolla, CA 92037-4802 | 2016-02-15 |
| 1831561307 | Willow Buckley | Special Hospital | 1840 Gatepost Rd, Encinitas, CA 92024-3021 | 2015-10-23 |
| 1063893741 | Patricia Piper | Special Hospital | 6422 Old Redwood Hwy, Santa Rosa, CA 95403-1158 | 2015-06-17 |
| 1225416365 | Kristen Yee Md PC | Special Hospital | 1111 Sonoma Ave Ste 112, Santa Rosa, CA 95405-4813 | 2015-05-08 |
| 1326438813 | Amalia Zacher | Special Hospital | 7160 Santa Teresa Blvd, San Jose, CA 95139-1349 | 2015-02-04 |
| 1962800870 | June K Chang | Special Hospital | 4000 W Riverside Dr, B, Burbank, CA 91505-4328 | 2014-12-09 |
| 1174921092 | Hired Power Transitional Living Center LLC | Special Hospital | 21062 Brookhurst St Ste 201, Huntington Beach, CA 92646-7404 | 2014-12-09 |
| Find all providers with the same taxonomy | ||||
| City | LOMA LINDA |
| Zip Code | 92357 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.