Provider Demographics
NPI:1215124896
Name:VA MANILA OUTPATIENT CLINIC
Entity type:Organization
Organization Name:VA MANILA OUTPATIENT CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR, BUSINESS DEVELOPMENT
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:
Authorized Official - Last Name:MAYERICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:202-254-0339
Mailing Address - Street 1:2201 ROXA BLVD
Mailing Address - Street 2:
Mailing Address - City:PASAY CITY
Mailing Address - State:PHILILIPPINES
Mailing Address - Zip Code:1300
Mailing Address - Country:PH
Mailing Address - Phone:011632-833-4566
Mailing Address - Fax:
Practice Address - Street 1:2201 ROXA BLVD
Practice Address - Street 2:
Practice Address - City:PASAY CITY
Practice Address - State:PHILILIPPINES
Practice Address - Zip Code:1300
Practice Address - Country:PH
Practice Address - Phone:011632-833-4566
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MANILA -RO
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-09-27
Last Update Date:2007-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QV0200XAmbulatory Health Care FacilitiesClinic/CenterVA