Provider Demographics
NPI:1992956189
Name:VA GREATER LOS ANGELES HEALTHCARE SYSTEM
Entity type:Organization
Organization Name:VA GREATER LOS ANGELES HEALTHCARE SYSTEM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE MANAGER O/P MENTAL HEALTH
Authorized Official - Prefix:MRS
Authorized Official - First Name:HELEN
Authorized Official - Middle Name:
Authorized Official - Last Name:BONANOMI
Authorized Official - Suffix:
Authorized Official - Credentials:MSN, RN, CARN
Authorized Official - Phone:310-471-3711
Mailing Address - Street 1:13603 S MARIPOSA AVE
Mailing Address - Street 2:
Mailing Address - City:GARDENA
Mailing Address - State:CA
Mailing Address - Zip Code:90247-2005
Mailing Address - Country:US
Mailing Address - Phone:310-719-7187
Mailing Address - Fax:
Practice Address - Street 1:13603 S MARIPOSA AVE
Practice Address - Street 2:
Practice Address - City:GARDENA
Practice Address - State:CA
Practice Address - Zip Code:90247-2005
Practice Address - Country:US
Practice Address - Phone:310-719-7187
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-06
Last Update Date:2008-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN306586261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health