MEDICARE: JENNIFER LYNN JOTHEN D.O.

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	390200000X	Student in an Organized Health Care Education/Training Program		CA
2	2084N0400X	Neurology Physician	20A10603	CA

General Provider Information

NPI Number	:	1891957221
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER LYNN JOTHEN D.O.

Provider Business Mailing Address
First Line	:	PO BOX 181337
Second Line	:
City	:	CORONADO
State	:	CA
Zip	:	92178-1337
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	752 MEDICAL CENTER CT STE 210
Second Line	:
City	:	CHULA VISTA
State	:	CA
Zip	:	91911-6660
Country	:	US
Telephone Number	:	619-656-0206
Fax Number	:

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

Provider Enumeration Date	:	06/26/2008
Last Update Date	:	07/12/2014

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