Healthcare Provider Details

I. General information

NPI: 1558026708
Provider Name (Legal Business Name): LLUH EDUCATION CONSORTIUM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2021
Last Update Date: 11/03/2021
Certification Date: 11/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24785 STEWART ST EVANS HALL SUITE 204
LOMA LINDA CA
92350-0001
US

IV. Provider business mailing address

24785 STEWART ST EVANS HALL SUITE 204
LOMA LINDA CA
92350-0001
US

V. Phone/Fax

Practice location:
  • Phone: 909-558-4000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name: DR. WASEEM KHADER
Title or Position: FELLOW
Credential: DO
Phone: 909-558-4000