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General NPI Number Information
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NPI Number | 1154750982
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Entity Type | Organization
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Legal Business Name | LLUMC TRANSPLANT INSTITUTE
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Dates
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Enumeration Date | 11/02/2013
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Last Update Date | 11/02/2013
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Provider Practice Location Address
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Address Line | 25865 BARTON RD STE 101
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City | LOMA LINDA
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State | CA
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Zip | 92354-3896
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Country | US
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Telephone | 909-558-3636
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Fax |
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Provider Business Mailing Address
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Address Line | 24975 PROSPECT AVE
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City | LOMA LINDA
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State | CA
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Zip | 92354-2842
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | SERVICE LINE DIRECTOR
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Name | JUDY REYNOLDS
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Credential | RN MBA
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Telephone | 909-558-3636
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 282N00000X
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Taxonomy Name | General Acute Care Hospital
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License Number | 51272
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License Number State | CA
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