Healthcare Provider Details

I. General information

NPI: 1639756919
Provider Name (Legal Business Name): DYLAN PURKISS DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2021
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11234 ANDERSON ST
LOMA LINDA CA
92354-2804
US

IV. Provider business mailing address

11175 CAMPUS ST
LOMA LINDA CA
92350-1700
US

V. Phone/Fax

Practice location:
  • Phone: 562-328-6063
  • Fax:
Mailing address:
  • Phone: 909-558-9759
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number20A22927
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: