Loma Linda University Urology Medical Group, Inc.

Primary specialty

Urology PhysicianTaxonomy code 208800000X

License

GR0056040 Issued in CA

Legal business name

LOMA LINDA UNIVERSITY UROLOGY MEDICAL GROUP, INC.

Practice address

400 N Pepper Ave
Urology Dept-6TH Floor
Colton, CA 92324-1801

Phone

(909) 885-5150

NPI assigned

Oct 26, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Herbert Ruckle, M.D.

Title

Group Director

Phone

(909) 885-5150

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1193356800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1193356800000",
    "number": "1447439351",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 5157",
            "city": "SAN BERNARDINO",
            "state": "CA",
            "postal_code": "924125157",
            "telephone_number": "909-885-5150"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 N PEPPER AVE",
            "address_2": "UROLOGY DEPT-6TH FLOOR",
            "city": "COLTON",
            "state": "CA",
            "postal_code": "923241801",
            "telephone_number": "909-885-5150"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LOMA LINDA UNIVERSITY UROLOGY MEDICAL GROUP, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-10-26",
        "last_updated": "2007-10-26",
        "status": "A",
        "authorized_official_last_name": "RUCKLE",
        "authorized_official_first_name": "HERBERT",
        "authorized_official_title_or_position": "GROUP DIRECTOR",
        "authorized_official_telephone_number": "909-885-5150",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Urology",
            "state": "CA",
            "license": "GR0056040",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0056040",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GROUP NUMBER",
            "identifier": "ZZZ33529Z",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Luz Stacy Loera
• Kendrick Wayne Logan
• Sue Logsdon
• Loma Linda Hospice & Palliative Care
• Loma Linda University Radiology Medical Group, Inc
• Erick Lomeli
• Haleigh Christine Loomis, PA-C
• Darrin Looysen
• Andrew Lopez, RRA
• Christian Javier Lopez

• Urology Physician in Colton, CA
• Providers in Colton, CA by specialty
• Urology Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 26, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.