Healthcare Provider Details

I. General information

NPI: 1356599310
Provider Name (Legal Business Name): JENNIFER A VELTMAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2008
Last Update Date: 06/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11234 ANDERSON ST # MC-1516
LOMA LINDA CA
92354-2804
US

IV. Provider business mailing address

11234 ANDERSON ST # MC-1516
LOMA LINDA CA
92354-2804
US

V. Phone/Fax

Practice location:
  • Phone: 909-558-4499
  • Fax:
Mailing address:
  • Phone: 313-745-4525
  • Fax: 313-577-3777

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number4301092896
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA121822
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number4301092896
License Number StateMI
# 4
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License NumberA121822
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4301092896
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: