Organization
VICTOR VALLEY COMMUNITY HOSPITAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BERTA BETETA (INTERIM CHIEF FINANCIAL OFFICER)
(760) 245-8691
Entity
Organization
Contact information
Practice address
15248 11TH ST, VICTORVILLE, CA 92395-3704
(760) 245-8691
(760) 843-6049
Mailing address
15248 11TH ST, VICTORVILLE, CA 92395-3704
(760) 245-8691
(760) 843-6049
Taxonomy
Speciality
Code
Description
License number
State
282N00000X
General Acute Care Hospital
Primary
—
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000000000020
—
CA
01
—
0010
TRICARE
CA
05
—
ZZT30517F
—
CA
01
—
ZZZC3616Z
BLUE SHIELD
CA
Enumeration date
08/09/2006
Last updated
08/22/2020
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