Provider Demographics
NPI:1871539783
Name:VA NORTHERN CALIFORNIA HEALTH CARE SYSTEM
Entity type:Organization
Organization Name:VA NORTHERN CALIFORNIA HEALTH CARE SYSTEM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOCIAL WORKER
Authorized Official - Prefix:MRS
Authorized Official - First Name:GERARDA
Authorized Official - Middle Name:W
Authorized Official - Last Name:PERSAD
Authorized Official - Suffix:
Authorized Official - Credentials:MSSW, LCSW
Authorized Official - Phone:916-561-7520
Mailing Address - Street 1:5342 DUDLEY BLVD
Mailing Address - Street 2:
Mailing Address - City:MCCLELLAN
Mailing Address - State:CA
Mailing Address - Zip Code:95652-1012
Mailing Address - Country:US
Mailing Address - Phone:916-561-7520
Mailing Address - Fax:916-561-7529
Practice Address - Street 1:5342 DUDLEY BLVD
Practice Address - Street 2:
Practice Address - City:MCCLELLAN
Practice Address - State:CA
Practice Address - Zip Code:95652-1012
Practice Address - Country:US
Practice Address - Phone:916-561-7520
Practice Address - Fax:916-561-7529
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-20
Last Update Date:2007-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY 3114302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization