Provider Demographics
NPI:1699939918
Name:LOMA LINDA UNIVERSITY
Entity type:Organization
Organization Name:LOMA LINDA UNIVERSITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE CHANCELLOR, LOMA LINDA UNIV
Authorized Official - Prefix:MR
Authorized Official - First Name:VERLON
Authorized Official - Middle Name:W
Authorized Official - Last Name:STRAUSS
Authorized Official - Suffix:
Authorized Official - Credentials:CPA,MBA
Authorized Official - Phone:909-558-4543
Mailing Address - Street 1:11092 ANDERSON STREET
Mailing Address - Street 2:LOMA LINDA UNIVERSITY, SCHOOL OF DENTISTRY
Mailing Address - City:LOMA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92354
Mailing Address - Country:US
Mailing Address - Phone:909-558-4613
Mailing Address - Fax:
Practice Address - Street 1:11092 ANDERSON STREET
Practice Address - Street 2:LOMA LINDA UNIVERSITY, SCHOOL OF DENTISTRY
Practice Address - City:LOMA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92354
Practice Address - Country:US
Practice Address - Phone:909-558-4613
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-16
Last Update Date:2008-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA57259261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental