MEDICARE: ROLANDA GOTT 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	208000000X	Pediatrics Physician	115060	MO
2	208000000X	Pediatrics Physician	153546	CA
3	2080P0006X	Developmental - Behavioral Pediatrics Physician	153546	CA

General Provider Information

NPI Number	:	1588617559
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROLANDA GOTT MD

Provider Business Mailing Address
First Line	:	5767 W CENTURY BLVD STE 400
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90045-5631
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	10833 LE CONTE AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90095-2514
Country	:	US
Telephone Number	:	310-206-8540
Fax Number	:

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

Provider Enumeration Date	:	05/18/2006
Last Update Date	:	04/27/2018

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