Organization
LOMA LINDA UNIVERSITY CARDIOLOGY MEDICAL GROUP, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KENNETH JUTZY M.D. (PRESIDENT)
(909) 558-4200
Entity
Organization
Contact information
Practice address
11234 ANDERSON ST, LOMA LINDA, CA 92354-2804
(909) 558-4200
(909) 558-7975
Mailing address
PO BOX 10427, SAN BERNARDINO, CA 92423-0427
(909) 558-8591
(909) 558-0118
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GR0042260
—
CA
Enumeration date
05/11/2006
Last updated
08/30/2007
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