MEDICARE: DR. JOSEPHINE LEAH VONHERZEN 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	207V00000X	Obstetrics & Gynecology Physician	MD24777	OR

General Provider Information

NPI Number	:	1821171133
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOSEPHINE LEAH VONHERZEN M.D.

Provider Business Mailing Address
First Line	:	823 GATEWAY CENTER WAY
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92102-4541
Country	:	US
Telephone Number	:	619-515-2323
Fax Number	:	619-906-4564

Provider Business Practice Location Address
First Line	:	1809 NATIONAL AVENUE
Second Line	:	LOGAN HEIGHTS FAMILY HEALTH CENTER
City	:	SAN DIEGO
State	:	CA
Zip	:	92113
Country	:	US
Telephone Number	:	619-515-2300
Fax Number	:	619-234-2447

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

Provider Enumeration Date	:	10/23/2006
Last Update Date	:	12/03/2010

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