Healthcare Provider Details

I. General information

NPI: 1801909478
Provider Name (Legal Business Name): VA LOMA LINDA HEALTH CARE SYSTEM (112G)
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25915 BROOKMERE AVE
LOMA LINDA CA
92354-3966
US

IV. Provider business mailing address

25915 BROOKMERE AVE.,
LOMA LINDA CA
92354
US

V. Phone/Fax

Practice location:
  • Phone: 909-796-9792
  • Fax:
Mailing address:
  • Phone: 909-796-9792
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code286500000X
TaxonomyMilitary Hospital
License Number29330
License Number StateKY

VIII. Authorized Official

Name: DR. MATILAL CHHOTABHAI PATEL I
Title or Position: ATTENDING ORTHRPEDICS
Credential: MD
Phone: 909-825-7084