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General NPI Number Information
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NPI Number | 1902928393
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Entity Type | Organization
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Legal Business Name | LOMA VIEW PEDIATRIC MEDICAL CLINIC, INC.
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Dates
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Enumeration Date | 04/04/2007
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Last Update Date | 07/02/2015
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Provider Practice Location Address
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Address Line | 1684 PLUM LN STE 101
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City | REDLANDS
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State | CA
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Zip | 92374-4596
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Country | US
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Telephone | 909-475-5800
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Fax | 909-475-5805
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Provider Business Mailing Address
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Address Line | 1684 PLUM LN STE 101
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City | REDLANDS
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State | CA
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Zip | 92374-4596
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Country | US
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Telephone | 909-475-5800
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Fax | 909-475-5805
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Authorized Official
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Title or Position | PRESIDENT
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Name | ERNESTO CRUZ
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Credential | M.D.
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Telephone | 909-475-5800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | G49014
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License Number State | CA
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