MEDICARE: VERONIQUE HEDWIGE JOTTERAND M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207W00000X	Ophthalmology Physician	G54415	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	00G544150	OTHER	CA	MEDICAL PPIN #

General Provider Information

NPI Number	:	1083636187
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VERONIQUE HEDWIGE JOTTERAND M.D.

Provider Business Mailing Address
First Line	:	2865 ATLANTIC AVE
Second Line	:	SUITE 109
City	:	LONG BEACH
State	:	CA
Zip	:	90806-1740
Country	:	US
Telephone Number	:	562-988-2020
Fax Number	:	562-426-7394

Provider Business Practice Location Address
First Line	:	2865 ATLANTIC AVE
Second Line	:	SUITE 109
City	:	LONG BEACH
State	:	CA
Zip	:	90806-1740
Country	:	US
Telephone Number	:	562-988-2020
Fax Number	:	562-426-7394

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/25/2006
Last Update Date	:	06/02/2010

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