Healthcare Provider Details

I. General information

NPI: 1750510293
Provider Name (Legal Business Name): JASPAL SINGH HOTHI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2009
Last Update Date: 12/28/2021
Certification Date: 12/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 E CAROLINE ST
SAN BERNARDINO CA
92408-3747
US

IV. Provider business mailing address

11175 CAMPUS STREET COLEMAN PAVILION-A1120
LOMA LINDA CA
92350-0001
US

V. Phone/Fax

Practice location:
  • Phone: 909-651-1900
  • Fax:
Mailing address:
  • Phone: 909-558-9626
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4301109495
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code2080P0214X
TaxonomyPediatric Pulmonology Physician
License NumberDR.0064007
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code2080S0012X
TaxonomyPediatric Sleep Medicine Physician
License Number4301109495
License Number StateMI
# 4
Primary TaxonomyY
Taxonomy Code2080P0214X
TaxonomyPediatric Pulmonology Physician
License NumberC172970
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code2080P0214X
TaxonomyPediatric Pulmonology Physician
License Number4301109495
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: