MEDICARE: LOMA LINDA UNIV PHYSICIANS 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	207R00000X	Internal Medicine Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1669428595
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LOMA LINDA UNIV PHYSICIANS MEDICAL GROUP INC

Provider Business Mailing Address
First Line	:	FILE NUMBER 56994
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90074-6994
Country	:	US
Telephone Number	:	909-558-3111
Fax Number	:	909-558-3905

Provider Business Practice Location Address
First Line	:	27990 SHERMAN ROAD
Second Line	:
City	:	SUN CITY
State	:	CA
Zip	:	92585
Country	:	US
Telephone Number	:	951-679-7412
Fax Number	:	909-558-3905

Authorized Official
Title or Position	:	PRESIDENT LLU PHYSICIANS MEDICAL GR
Name	:	JAMES COUPERUS
Credential	:	MD
Telephone Number	:	909-558-2191

Provider Enumeration Date	:	05/25/2006
Last Update Date	:	10/02/2007

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