Healthcare Provider Details

I. General information

NPI: 1154750982
Provider Name (Legal Business Name): LLUMC TRANSPLANT INSTITUTE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2013
Last Update Date: 11/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25865 BARTON RD STE 101
LOMA LINDA CA
92354-3896
US

IV. Provider business mailing address

24975 PROSPECT AVE
LOMA LINDA CA
92354-2842
US

V. Phone/Fax

Practice location:
  • Phone: 909-558-3636
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number51272
License Number StateCA

VIII. Authorized Official

Name: JUDY REYNOLDS
Title or Position: SERVICE LINE DIRECTOR
Credential: RN MBA
Phone: 909-558-3636