1326051806 NPI number — GWEN M. ALLEN MD INC

Table of content: (NPI 1326051806)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326051806 NPI number — GWEN M. ALLEN MD INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GWEN M. ALLEN MD INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1326051806
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/05/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1141 W REDONDO BEACH BLVD STE 402
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GARDENA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90247-3582
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
310-329-9492
Provider Business Mailing Address Fax Number:
310-329-6314

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1045 W REDONDO BEACH BLVD
Provider Second Line Business Practice Location Address:
SUITE 500
Provider Business Practice Location Address City Name:
GARDENA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90247-4128
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-329-9492
Provider Business Practice Location Address Fax Number:
310-329-3799
Provider Enumeration Date:
08/14/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ALLEN
Authorized Official First Name:
GWEN
Authorized Official Middle Name:
MARIA
Authorized Official Title or Position:
PRESIDENT/ CEO
Authorized Official Telephone Number:
310-329-9492

Provider Taxonomy Codes

  • Taxonomy code: 207VG0400X , with the licence number:  A061790 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 00A617900 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com