Provider Demographics
NPI:1275637324
Name:SEVENTH-DAY ADVENTISTS LOMA LINDA UNIVERSITY MEDICAL CENTER
Entity Type:Organization
Organization Name:SEVENTH-DAY ADVENTISTS LOMA LINDA UNIVERSITY MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TREVOR
Authorized Official - Middle Name:
Authorized Official - Last Name:WRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-558-4000
Mailing Address - Street 1:11255 MOUNTAIN VIEW AVE
Mailing Address - Street 2:LLUMC-MOUNTAIN VIEW PHARMACEUTICALS STE #A
Mailing Address - City:LOMA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92354-3864
Mailing Address - Country:US
Mailing Address - Phone:909-558-3088
Mailing Address - Fax:
Practice Address - Street 1:11255 MOUNTAIN VIEW AVE
Practice Address - Street 2:LLUMC-MOUNTAIN VIEW PHARMACEUTICALS STE #A
Practice Address - City:LOMA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92354-3864
Practice Address - Country:US
Practice Address - Phone:909-558-3088
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-11
Last Update Date:2022-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA310953336H0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZ31174ZOtherBLUE SHIELD OF CALIFORNIA
CAPHA310950Medicaid
CAZZ31174ZOtherBLUE SHIELD OF CALIFORNIA