LONG BEACH VAMC (NPI# 1396378030) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1396378030 |
| Entity Type | Organization |
| Organization Name | LONG BEACH VAMC |
| Practice Address |
1149 W 190th St Ste 100 Gardena CA 90248-4321 |
| Mailing Address |
Po Box 94407 Cleveland OH 44101-4407 |
| Practice Telephone | 7023413152 |
| Practice Fax Number | 7023413503 |
| Mailing Telephone | 7023413152 |
| Mailing Fax Number | 7023413503 |
| Enumeration Date | 2020-02-21 |
| Last Update Date | 2020-02-21 |
| Authorized Official Name | ERIN DENISE POTTER (NPI TEAM LEAD) |
| Authorized Official Telephone | 2023822579 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QV0200X |
Clinic/Center Specialization: VA |
Ambulatory Health Care Facilities |
| Other Name | Type Code |
|---|---|
| GARDENA VA CLINIC | Other Name - Individual/Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1538550694 | Long Beach Vamc | Clinic/Center | 888 West Santa Ana Blvd, Suite 150, Santa Ana, CA 92701-4592 | 2015-02-11 |
| 1700060845 | Long Beach Vamc | Clinic/Center | 23719 Moulton Pkwy, Laguna Hills, CA 92653-1913 | 2007-12-26 |
| 1841239712 | Long Beach Vamc | Clinic/Center | 10330 Pioneer Blvd Ste 180, Santa Fe Springs, CA 90670-6012 | 2006-06-06 |
| 1598703563 | Long Beach Vamc | Clinic/Center | 1506 Brookhollow Dr, Suite 100, Santa Ana, CA 92705-5405 | 2006-06-03 |
| 1053362756 | Long Beach Vamc | Clinic/Center | 2001 River Ave, Building 28, Long Beach, CA 90810-3622 | 2006-05-15 |
| 1699726851 | Long Beach Vamc | Clinic/Center | 2569 W Woodland Dr, Anaheim, CA 92801-2608 | 2006-05-12 |
| 1730549049 | Long Beach Vamc | Skilled Nursing Facility | 5901 E 7th St, Long Beach, CA 90822-5201 | 2016-02-29 |
| 1386041754 | Long Beach Vamc | Clinic/Center | 5901 E 7th St, Long Beach, CA 90822-5201 | 2014-12-01 |
| 1306090824 | Long Beach Vamc | Rehabilitation Hospital | 5901 E 7th St, Long Beach, CA 90822-5201 | 2008-11-11 |
| 1003866468 | Long Beach Vamc | General Acute Care Hospital | 5901 E 7th St, Long Beach, CA 90822-5201 | 2006-05-10 |
| Street Address |
1149 W 190TH ST STE 100 |
| City | GARDENA |
| State | CA |
| Zip Code | 90248-4321 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1215537543 | Gereine Mae Condino Datan | Nurse Practitioner | 500 W 190 St, Gardena, CA 90248 | 2020-10-27 |
| 1154811297 | Patrick Lee | Technician/Technologist | 18203 S. Western Ave Ste. 102, Torrance, CA 90248 | 2018-05-15 |
| 1386152445 | Ariana Felicitas Nieves | Behavioral Analyst | 870 W 190th St Ste 400, Gardena, CA 90248 | 2018-01-11 |
| 1265949606 | Jessica Keller | Behavioral Analyst | 879 W 190th St Suite 400, Gardena, CA 90248 | 2018-01-08 |
| 1265941199 | Jaimee E Munson | Behavioral Analyst | 18726 S. Western Ave St, #408, Gardena, CA 90248 | 2017-09-22 |
| 1922467349 | Fred Jefferson Memorial Homes | Substance Abuse Rehabilitation Facility | 152 W. Walnut, Suite 150, Gardena, CA 90248 | 2016-02-12 |
| 1922427442 | Shana Reilly | Behavioral Analyst | 18726 S. Western Ave., Suite 408, Los Angeles, CA 90248 | 2014-04-11 |
| 1588002216 | Aacres Ca, LLC | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 19300 S. Hamilton Ave, Ste 130, Gardena, CA 90248 | 2013-06-04 |
| 1093057598 | Aids Health Foundation | Pharmacist | 19300 S. Hamilton Ave., Ste 170, Gardena, CA 90248 | 2013-03-22 |
| 1245576594 | Hye Mi Kim | Behavioral Analyst | 18726 S. Western Ave.,#408, Gardena, CA 90248 | 2012-12-13 |
| Find all providers in zip 90248 | ||||
| Taxonomy Code | 261QV0200X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | VA |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1780638254 | West Los Angeles Vamc | Clinic/Center | 1149 W 190th St, First Floor, Gardena, CA 90248-4321 | 2006-05-20 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1841831617 | West Los Angeles Vamc | Clinic/Center | 7 W Foothill Blvd Ste D, Arcadia, CA 91006-2367 | 2019-10-03 |
| 1255972303 | William Loushion Mccollum | Clinic/Center | 831 Gulf Ave, Wilmington, CA 90744-4201 | 2019-09-30 |
| 1851943104 | Martinez Vamc | Clinic/Center | 11985 Heritage Oak Pl Ste 100, Auburn, CA 95603-2413 | 2019-07-16 |
| 1073064408 | Martinez Vamc | Clinic/Center | 2860 Howe Rd, Martinez, CA 94553-4000 | 2016-10-20 |
| 1548651516 | Loma Linda Vamc | Clinic/Center | 1273 W Hobsonway, Blythe, CA 92225-1423 | 2015-02-12 |
| 1538550694 | Long Beach Vamc | Clinic/Center | 888 West Santa Ana Blvd, Suite 150, Santa Ana, CA 92701-4592 | 2015-02-11 |
| 1780089847 | Yin Yang Health Care | Clinic/Center | 538 S Murphy Ave, Sunnyvale, CA 94086-6116 | 2014-10-30 |
| 1144638958 | Martinez Vamc | Clinic/Center | 101 East Oberlin Road, Yreka, CA 96097-9645 | 2014-07-24 |
| 1447523196 | Martinez Vamc | Clinic/Center | 425 Plumas Blvd, Yuba City, CA 95991-5074 | 2012-02-10 |
| 1336466598 | Reno Vamc | Clinic/Center | 110 Bella Way, Susanville, CA 96130-9102 | 2010-04-28 |
| Find all providers with the same taxonomy | ||||
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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.