Healthcare Provider Details

I. General information

NPI: 1366655359
Provider Name (Legal Business Name): PAUL CLIFFORD HERRMANN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11234 ANDERSON ST RM 2516
LOMA LINDA CA
92354-2804
US

IV. Provider business mailing address

LLUMC, HOUSE STAFF OFFICE CP21005 11234 ANDERSON STREET
LOMA LINDA CA
92354
US

V. Phone/Fax

Practice location:
  • Phone: 909-558-4000
  • Fax:
Mailing address:
  • Phone: 909-558-4094
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZH0000X
TaxonomyHematology (Pathology) Physician
License NumberA95062
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207ZP0101X
TaxonomyAnatomic Pathology Physician
License NumberA95062
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code207ZP0105X
TaxonomyClinical Pathology/Laboratory Medicine Physician
License NumberA95062
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: