Healthcare Provider Details

I. General information

NPI: 1174504757
Provider Name (Legal Business Name): GRETCHEN CHRISTINE GAINOR M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: GRETCHEN CHRISTINE GAINOR M.D.

II. Dates (important events)

Enumeration Date: 11/09/2005
Last Update Date: 05/19/2021
Certification Date: 05/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7300 GIRARD AVE
LA JOLLA CA
92037-5138
US

IV. Provider business mailing address

7300 GIRARD AVE
LA JOLLA CA
92037-5138
US

V. Phone/Fax

Practice location:
  • Phone: 858-459-4351
  • Fax: 858-459-4399
Mailing address:
  • Phone: 858-459-4351
  • Fax: 858-459-4399

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberG79066
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: