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General NPI Number Information
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NPI Number | 1730834904
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Entity Type | Organization
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Legal Business Name | LOMA LINDA SURGICAL INSTITUTE, LLC
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Dates
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Enumeration Date | 02/16/2022
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Last Update Date | 07/31/2023
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Provider Practice Location Address
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Address Line | 25915 BARTON ROAD
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City | LOMA LINDA
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State | CA
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Zip | 92354
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Country | US
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Telephone | 714-394-6465
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 373
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City | LOMA LINDA
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State | CA
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Zip | 92354-0373
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Country | US
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Telephone | 714-394-6465
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Fax |
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Authorized Official
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Title or Position | ADMNISTRATOR
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Name | TAMMY RENELL TANNER
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Credential |
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Telephone | 714-394-6465
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number |
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License Number State |
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