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1659664654

NPI Code Detail

MEDICARE: LOMA LINDA UNIVERSITY PATHOLOGY MEDICAL GROUP, INC.

MEDICARE: LOMA LINDA UNIVERSITY PATHOLOGY MEDICAL GROUP, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207ZB0001X	Blood Banking & Transfusion Medicine Physician	05D2021238	CA
2	207ZC0500X	Cytopathology Physician	05D2021238	CA
3	207ZF0201X	Forensic Pathology Physician	05D2021238	CA
4	207ZH0000X	Hematology (Pathology) Physician	05D2021238	CA
5	207ZM0300X	Medical Microbiology Physician	05D2021238	CA
6	207ZN0500X	Neuropathology Physician	05D2021238	CA
7	207ZP0007X	Molecular Genetic Pathology (Pathology) Physician	05D2021238	CA
8	207ZP0213X	Pediatric Pathology Physician	05D2021238	CA
9	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician	05D2021238	CA

General Provider Information

NPI Number	:	1659664654
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LOMA LINDA UNIVERSITY PATHOLOGY MEDICAL GROUP, INC.

Provider Business Mailing Address
First Line	:	PO BOX 1740
Second Line	:
City	:	LOMA LINDA
State	:	CA
Zip	:	92354-0240
Country	:	US
Telephone Number	:	909-558-5170
Fax Number	:	909-793-8728

Provider Business Practice Location Address
First Line	:	28062 BAXTER RD
Second Line	:
City	:	MURRIETA
State	:	CA
Zip	:	92563-1401
Country	:	US
Telephone Number	:	951-290-4580
Fax Number	:	951-290-4932

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. PAUL HERMANN
Credential	:	M.D.
Telephone Number	:	909-558-5175

Provider Enumeration Date	:	05/24/2011
Last Update Date	:	12/16/2022

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Directions to “LOMA LINDA UNIVERSITY PATHOLOGY MEDICAL GROUP, INC. ” Practice Location

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