MEDICARE: JEROME DE VENTE MD

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	207RI0200X	Infectious Disease Physician	A71061	CA

General Provider Information

NPI Number	:	1548208242
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEROME DE VENTE MD

Provider Business Mailing Address
First Line	:	1043 ELM AVE
Second Line	:	SUITE 300
City	:	LONG BEACH
State	:	CA
Zip	:	90813-3271
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1043 ELM AVE
Second Line	:	SUITE 300
City	:	LONG BEACH
State	:	CA
Zip	:	90813-3271
Country	:	US
Telephone Number	:	562-624-4999
Fax Number	:

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

Provider Enumeration Date	:	06/03/2006
Last Update Date	:	09/07/2007

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