Loma Linda University Urology Medical Group, Inc.

NPI #1619104155 in Beaumont, California

Provider Information

NPI Number: 1619104155
Entity Type: Organization
Organization Name: Loma Linda University Urology Medical Group, Inc.
Primary Specialty: Urology
Enumeration Date: Jun 11, 2009
Last Updated: Jun 19, 2009

Practice Location

Address: 81 HIGHLAND SPRINGS AVE.
Address 2: STE. 103
City: Beaumont
State: California
ZIP Code: 92223-2511
Phone: (909) 558-2830

Authorized Official

Name: HERBERT RUCKLE, M.D.
Title: PRESIDENT
Phone: (909) 558-2830

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Urology	208800000X	Primary

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