Provider Demographics
NPI:1730834904
Name:LOMA LINDA SURGICAL INSTITUTE, LLC
Entity type:Organization
Organization Name:LOMA LINDA SURGICAL INSTITUTE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMNISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:RENELL
Authorized Official - Last Name:TANNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-394-6465
Mailing Address - Street 1:PO BOX 373
Mailing Address - Street 2:
Mailing Address - City:LOMA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92354-0373
Mailing Address - Country:US
Mailing Address - Phone:714-394-6465
Mailing Address - Fax:
Practice Address - Street 1:25915 BARTON ROAD
Practice Address - Street 2:
Practice Address - City:LOMA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92354
Practice Address - Country:US
Practice Address - Phone:714-394-6465
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-16
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty