Provider Demographics
NPI:1093239030
Name:LOMA LINDA MEDICAL CLINIC
Entity Type:Organization
Organization Name:LOMA LINDA MEDICAL CLINIC
Other - Org Name:TRINITY PEDIATRICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:M.D.
Authorized Official - Prefix:
Authorized Official - First Name:REBECA
Authorized Official - Middle Name:EILEEN
Authorized Official - Last Name:PIANTINI-ALVAREZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:909-528-5119
Mailing Address - Street 1:273 E OVILLA RD STE 4
Mailing Address - Street 2:
Mailing Address - City:RED OAK
Mailing Address - State:TX
Mailing Address - Zip Code:75154-2605
Mailing Address - Country:US
Mailing Address - Phone:972-617-6660
Mailing Address - Fax:
Practice Address - Street 1:273 E OVILLA RD STE 4
Practice Address - Street 2:
Practice Address - City:RED OAK
Practice Address - State:TX
Practice Address - Zip Code:75154-2605
Practice Address - Country:US
Practice Address - Phone:972-617-6660
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-01
Last Update Date:2019-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL0512208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty