Provider Demographics
NPI:1801909478
Name:VA LOMA LINDA HEALTH CARE SYSTEM (112G)
Entity type:Organization
Organization Name:VA LOMA LINDA HEALTH CARE SYSTEM (112G)
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ATTENDING ORTHRPEDICS
Authorized Official - Prefix:DR
Authorized Official - First Name:MATILAL
Authorized Official - Middle Name:CHHOTABHAI
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:I
Authorized Official - Credentials:MD
Authorized Official - Phone:909-825-7084
Mailing Address - Street 1:25915 BROOKMERE AVE.,
Mailing Address - Street 2:
Mailing Address - City:LOMA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92354
Mailing Address - Country:US
Mailing Address - Phone:909-796-9792
Mailing Address - Fax:
Practice Address - Street 1:25915 BROOKMERE AVE
Practice Address - Street 2:
Practice Address - City:LOMA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92354-3966
Practice Address - Country:US
Practice Address - Phone:909-796-9792
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY29330286500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes286500000XHospitalsMilitary Hospital