1790030773 NPI number — SEVENTH DAY ADVENTISTS LOMA LINDA UNIVERSITY MEDICAL CENTER, INC.

Table of content: (NPI 1790030773)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790030773 NPI number — SEVENTH DAY ADVENTISTS LOMA LINDA UNIVERSITY MEDICAL CENTER, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SEVENTH DAY ADVENTISTS LOMA LINDA UNIVERSITY MEDICAL CENTER, INC.
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:
6
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:
1790030773
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/13/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
81 HIGHLAND SPRINGS AVE
Provider Second Line Business Mailing Address:
SUITE 90
Provider Business Mailing Address City Name:
BEAUMONT
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92223-3170
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
951-849-3378
Provider Business Mailing Address Fax Number:
951-849-3332

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
81 HIGHLAND SPRINGS AVE
Provider Second Line Business Practice Location Address:
SUITE 90
Provider Business Practice Location Address City Name:
BEAUMONT
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92223-3170
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
951-849-3378
Provider Business Practice Location Address Fax Number:
951-849-3332
Provider Enumeration Date:
07/17/2012

Additional Information

Authorized Official

Authorized Official Last Name:
HEINRICH
Authorized Official First Name:
KERRY
Authorized Official Middle Name:
LYNN
Authorized Official Title or Position:
CHIEF EXECUTIVE OFFICER
Authorized Official Telephone Number:
909-558-4308

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X , with the licence number:  PHY50933 , 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: 5644720 . This is a "NCPDP PROVIDER IDENTIFICATION NUMBER" identifier . This identifiers is of the category "OTHER".




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