Healthcare Provider Details

I. General information

NPI: 1265648018
Provider Name (Legal Business Name): VA HOSPITAL LOMA LINDA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2007
Last Update Date: 06/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

VA HOSPITAL LOMA LINDA 11201 BENTON ST.
LOMA LINDA CA
92357-0001
US

IV. Provider business mailing address

4850 BLUE COPPER WAY
HEMET CA
92545-8938
US

V. Phone/Fax

Practice location:
  • Phone: 909-583-6009
  • Fax:
Mailing address:
  • Phone: 951-775-7276
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code286500000X
TaxonomyMilitary Hospital
License Number
License Number State

VIII. Authorized Official

Name: MRS. RENEE ELIZABETH ERNST
Title or Position: REGISTERED NURSE
Credential: RN
Phone: 909-583-6009