Healthcare Provider Details

I. General information

NPI: 1164528741
Provider Name (Legal Business Name): ANDREW JAY GELLENS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2006
Last Update Date: 02/01/2023
Certification Date: 02/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8851 CENTER DR 210
LA MESA CA
91942
US

IV. Provider business mailing address

8851 CENTER DR 210
LA MESA CA
91942
US

V. Phone/Fax

Practice location:
  • Phone: 619-463-7775
  • Fax: 619-463-4181
Mailing address:
  • Phone: 619-463-7775
  • Fax: 619-463-4181

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License NumberG71477
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: