1124185194 NPI number — LOMA LINDA UNIVERISTY

Table of content: (NPI 1124185194)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124185194 NPI number — LOMA LINDA UNIVERISTY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LOMA LINDA UNIVERISTY
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1124185194
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/18/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
LOMA LINDA UNIVERSITY--SCHOOL OF DENTISTRY
Provider Second Line Business Mailing Address:
11092 ANDERSON STREET
Provider Business Mailing Address City Name:
LOMA LINDA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92354
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
909-558-4613
Provider Business Mailing Address Fax Number:
909-558-4192

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
LOMA LINDA UNIVERSITY--SCHOOL OF DENTISTRY
Provider Second Line Business Practice Location Address:
11092 ANDERSON STREET
Provider Business Practice Location Address City Name:
LOMA LINDA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92354
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
909-558-4613
Provider Business Practice Location Address Fax Number:
909-558-4192
Provider Enumeration Date:
01/02/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
NEAL
Authorized Official First Name:
RODNEY
Authorized Official Middle Name:
DALE
Authorized Official Title or Position:
VICE PRESIDENT
Authorized Official Telephone Number:
909-558-4543

Provider Taxonomy Codes

  • Taxonomy code: 1223P0300X , with the licence number:  2043 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: G02000-01 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".