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General NPI Number Information
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NPI Number | 1730416140
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Entity Type | Organization
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Legal Business Name | LOMA LINDA ONCOLOGY MEDICAL GROUP
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Dates
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Enumeration Date | 11/05/2009
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Last Update Date | 11/05/2009
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Provider Practice Location Address
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Address Line | 10408 INDUSTRIAL CIR
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City | REDLANDS
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State | CA
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Zip | 92374-4548
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Country | US
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Telephone | 909-796-4333
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Fax |
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Provider Business Mailing Address
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Address Line | 10408 INDUSTRIAL CIRCLE
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City | REDLANDS
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State | CA
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Zip | 92374-4548
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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 | PRESIDENT
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Name | DR. IMTIAZ AKRAM MALIK
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Credential | M.D.
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Telephone | 909-796-4333
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RX0202X
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Taxonomy Name | Medical Oncology Physician
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License Number | A39816
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License Number State | CA
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