Healthcare Provider Details

I. General information

NPI: 1912929407
Provider Name (Legal Business Name): SEVENTH-DAY ADVENTISTS LOMA LINDA UNIVERSITY MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2006
Last Update Date: 03/08/2022
Certification Date: 03/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11234 ANDERSON ST
LOMA LINDA CA
92354-2804
US

IV. Provider business mailing address

11234 ANDERSON ST RM 1147
LOMA LINDA CA
92354-2804
US

V. Phone/Fax

Practice location:
  • Phone: 909-558-4500
  • Fax: 909-558-0362
Mailing address:
  • Phone: 909-558-5075
  • Fax: 909-558-8773

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHY50973
License Number StateCA

VIII. Authorized Official

Name: TREVOR WRIGHT
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 909-558-5075