| Loma Linda University | |
|
159 W Hospitality Ln Ste 201 San Bernardino CA 92408-3348 | |
| (909) 558-4616 | |
| (909) 651-3096 |
| Full Name | Loma Linda University |
|---|---|
| Speciality | Dentist - Orthodontics And Dentofacial Orthopedics |
| Location | 159 W Hospitality Ln Ste 201, San Bernardino, California |
| Authorized Official Name and Position | Rodney D Neal (VICE CHANCELLOR--LOMA LINDA UNIV.) |
| Authorized Official Contact | 9095584543 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Loma Linda University 159 W Hospitality Ln Ste 201 San Bernardino CA 92408-3348 Ph: (909) 558-4616 | Loma Linda University 159 W Hospitality Ln Ste 201 San Bernardino CA 92408-3348 Ph: (909) 558-4616 |
| NPI Number | 1780740704 |
|---|---|
| Provider Enumeration Date | 12/28/2006 |
| Last Update Date | 11/27/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1780740704 | NPI | - | NPPES |
| G02000-02 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223X0400X | Dentist - Orthodontics And Dentofacial Orthopedics | 2007 (California) | Primary |
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