Provider Demographics
NPI:1558026708
Name:LLUH EDUCATION CONSORTIUM
Entity Type:Organization
Organization Name:LLUH EDUCATION CONSORTIUM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FELLOW
Authorized Official - Prefix:DR
Authorized Official - First Name:WASEEM
Authorized Official - Middle Name:
Authorized Official - Last Name:KHADER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:909-558-4000
Mailing Address - Street 1:24785 STEWART ST EVANS HALL SUITE 204
Mailing Address - Street 2:
Mailing Address - City:LOMA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92350-0001
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:24785 STEWART ST EVANS HALL SUITE 204
Practice Address - Street 2:
Practice Address - City:LOMA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92350-0001
Practice Address - Country:US
Practice Address - Phone:909-558-4000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-03
Last Update Date:2021-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Multi-Specialty