Healthcare Provider Details

I. General information

NPI: 1023206729
Provider Name (Legal Business Name): LOMA LINDA MGMT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2007
Last Update Date: 10/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1011 17TH ST
BAKERSFIELD CA
93301-4703
US

IV. Provider business mailing address

1011 17TH ST
BAKERSFIELD CA
93301-4703
US

V. Phone/Fax

Practice location:
  • Phone: 661-322-4085
  • Fax:
Mailing address:
  • Phone: 661-322-4085
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number StateCA

VIII. Authorized Official

Name: SAMIR MOHAN
Title or Position: PRESIDENT
Credential:
Phone: 661-322-4085