Healthcare Provider Details

I. General information

NPI: 1497821490
Provider Name (Legal Business Name): JOHN C. GUNNELL, M.D.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/28/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

435 ARDEN AVE SUITE 520
GLENDALE CA
91203-1130
US

IV. Provider business mailing address

435 ARDEN AVE SUITE 520
GLENDALE CA
91203-1130
US

V. Phone/Fax

Practice location:
  • Phone: 818-247-5440
  • Fax: 818-241-8713
Mailing address:
  • Phone: 818-247-5440
  • Fax: 818-241-8713

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. ELI NATHAN GUNNELL
Title or Position: OFFICE MANAGER
Credential:
Phone: 818-247-5440