Healthcare Provider Details

I. General information

NPI: 1104022045
Provider Name (Legal Business Name): JULIE L GASPERINI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2007
Last Update Date: 05/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4300 LONG BEACH BLVD SUITE 300
LONG BEACH CA
90807-2011
US

IV. Provider business mailing address

4300 LONG BEACH BLVD SUITE 300
LONG BEACH CA
90807-2011
US

V. Phone/Fax

Practice location:
  • Phone: 562-984-7024
  • Fax: 562-428-7394
Mailing address:
  • Phone: 562-984-7024
  • Fax: 562-428-7394

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberA98995
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: