Organization
LOMA LINDA UNIVERSITY RADIOLOGY MEDICAL GROUP INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GERALD KIRK MD (CFO LLU RADIOLOGY MEDICAL GROUP INC)
(909) 558-3012
Entity
Organization
Contact information
Practice address
11234 ANDERSON ST, LOMA LINDA, CA 92354
(909) 558-3012
Mailing address
PO BOX 30959, LOS ANGELES, CA 90030-0959
(909) 558-3012
(909) 558-3292
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GR0011162
—
CA
Enumeration date
06/07/2006
Last updated
11/20/2007
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