Healthcare Provider Details

I. General information

NPI: 1033554613
Provider Name (Legal Business Name): LOMA LINDA INLAND CONSORTIUM FOR HEALTHCARE EDUCATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2013
Last Update Date: 09/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25455 BARTON RD SUITE 209-B
LOMA LINDA CA
92354-3128
US

IV. Provider business mailing address

24665 STEWART ST
LOMA LINDA CA
92354-2744
US

V. Phone/Fax

Practice location:
  • Phone: 909-558-6688
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. HOBART LEE
Title or Position: PROGRAM DIRECTOR
Credential: MD
Phone: 909-558-6688