Organization
JERRY L. PETTIS MEMORIAL VA MEDICAL CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DEAN STORDAHL (MEDICAL CENTER DIRECTOR)
(909) 825-7084
Entity
Organization
Contact information
Practice address
11201 BENTON ST, LOMA LINDA, CA 92357-1000
(909) 825-7084
Mailing address
116 N PLYMOUTH WAY, SAN BERNARDINO, CA 92408-4116
(909) 825-7084
Taxonomy
Speciality
Code
Description
License number
State
284300000X
Special Hospital
Primary
G03312
LA
Other
Enumeration date
12/06/2006
Last updated
08/22/2020
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