Provider Demographics
NPI:1427302017
Name:DEPARTMENT OF VA
Entity type:Organization
Organization Name:DEPARTMENT OF VA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE
Authorized Official - Prefix:MR
Authorized Official - First Name:VIRGILIO
Authorized Official - Middle Name:CORTEZ
Authorized Official - Last Name:ORENA
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:619-495-9941
Mailing Address - Street 1:1585 TRAILWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91913-2994
Mailing Address - Country:US
Mailing Address - Phone:619-495-9941
Mailing Address - Fax:
Practice Address - Street 1:1585 TRAILWOOD AVE
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91913-2994
Practice Address - Country:US
Practice Address - Phone:619-495-9941
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DEPARTMENT OF VA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-11-03
Last Update Date:2012-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes286500000XHospitalsMilitary Hospital