Organization
LOMA LINDA UNIV UROLOGY MEDICAL GROUP INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
HERBERT RUCKLE MD (PRESIDENT LLU UROLOGY MEDICAL GROUP)
(909) 558-2830
Entity
Organization
Contact information
Practice address
11370 ANDERSON ST, STE 1100, LOMA LINDA, CA 92354
(909) 558-2830
(909) 558-3905
Mailing address
FILE NUMBER 54701, LOS ANGELES, CA 90074-4701
(909) 558-3111
(909) 558-3905
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GR0041730
—
CA
Enumeration date
05/25/2006
Last updated
08/22/2020
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