Healthcare Provider Details

I. General information

NPI: 1649367186
Provider Name (Legal Business Name): SEVENTH-DAY ADVENTISTS LOMA LINDA UNIVERSITY MEDICAL CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25455 BARTON RD SUITE 111A
LOMA LINDA CA
92354-3128
US

IV. Provider business mailing address

25455 BARTON RD SUITE 111A
LOMA LINDA CA
92354-3128
US

V. Phone/Fax

Practice location:
  • Phone: 909-558-6447
  • Fax: 909-558-6155
Mailing address:
  • Phone: 909-558-6447
  • Fax: 909-558-6155

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHY44526
License Number StateCA

VIII. Authorized Official

Name: MR. KERRY LYNN HEINRICH
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 909-558-4308