MEDICARE: DR. JUSTIN CHRISTOPHER KERSTETTER M.D.

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	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician	A109169	CA
2	207ZD0900X	Dermatopathology (Pathology) Physician	A109169	CA

General Provider Information

NPI Number	:	1629241054
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JUSTIN CHRISTOPHER KERSTETTER M.D.

Provider Business Mailing Address
First Line	:	11234 ANDERSON ST
Second Line	:	ROOM 2115
City	:	LOMA LINDA
State	:	CA
Zip	:	92354-2804
Country	:	US
Telephone Number	:	909-558-4000
Fax Number	:

Provider Business Practice Location Address
First Line	:	11234 ANDERSON ST
Second Line	:	ROOM 2115
City	:	LOMA LINDA
State	:	CA
Zip	:	92354-2804
Country	:	US
Telephone Number	:	909-558-4000
Fax Number	:

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

Provider Enumeration Date	:	04/07/2008
Last Update Date	:	11/19/2015

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