1568630622 NPI number — LOMA LINDA UNIVERSITY MEDICAL CENTER

Table of content: (NPI 1568630622)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568630622 NPI number — LOMA LINDA UNIVERSITY MEDICAL CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LOMA LINDA UNIVERSITY MEDICAL CENTER
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:
1568630622
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/12/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11234 ANDERSON ST
Provider Second Line Business Mailing Address:
HOUSE STAFF OFFICE CP 21005
Provider Business Mailing Address City Name:
LOMA LINDA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92354-2804
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8265 E BLACKWILLOW CIR
Provider Second Line Business Practice Location Address:
APT. 112
Provider Business Practice Location Address City Name:
ANAHEIM
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92808-1958
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
714-637-3103
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/12/2008

Additional Information

Authorized Official

Authorized Official Last Name:
MEHR
Authorized Official First Name:
NEDA
Authorized Official Middle Name:
Authorized Official Title or Position:
RESIDENT PHYSICIAN
Authorized Official Telephone Number:
949-413-7336

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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