| NAME |
MARE ISLAND VA CLINIC |
| STATE |
CALIFORNIA |
| STREET ADDR. 1 |
201 WALNUT AVE |
| CITY |
VALLEJO |
| ZIP |
94592-1107 |
| OFFICIAL VA NAME |
MARE ISLAND VA CLINIC |
| STATUS |
National |
| ASSOCIATIONS |
|
| BILLING FACILITY NAME |
VALLEJO VA CBOC |
| ST. ADDR. 1 (MAILING) |
201 WALNUT AVE. |
| CITY (MAILING) |
VALLEJO |
| STATE (MAILING) |
CALIFORNIA |
| ZIP (MAILING) |
94592-1107 |
| EFFECTIVE DATE/TIME |
-
- 2007-01-08 00:00:00
- STATUS: ACTIVE
- NPI: 1962443572
|
| TAXONOMY CODE |
|
| LOCATION TIMEZONE |
PACIFIC |
| COUNTRY |
USA |
| AGENCY CODE |
VA |
| POINTER TO AGENCY |
VA |
| STATION NUMBER |
612GE |
| IDENTIFIER |
-
- CODING SYSTEM: NPI
- ID: 1962443572
-
- CODING SYSTEM: VASTANUM
- ID: 612GE
-
- CODING SYSTEM: CLIA
- ID: 05D1017011
|
