Healthcare Provider Details

I. General information

NPI: 1366646838
Provider Name (Legal Business Name): CECILIA LOH M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2007
Last Update Date: 11/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3660 PARK SIERRA DR SUITE 105
RIVERSIDE CA
92505-3081
US

IV. Provider business mailing address

3660 PARK SIERRA DR SUITE 105
RIVERSIDE CA
92505-3081
US

V. Phone/Fax

Practice location:
  • Phone: 951-278-8870
  • Fax:
Mailing address:
  • Phone: 951-278-8870
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number62103
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberA143602
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code2086S0105X
TaxonomySurgery of the Hand (Surgery) Physician
License NumberA143602
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: