Healthcare Provider Details

I. General information

NPI: 1841248143
Provider Name (Legal Business Name): GREGORY JAMES EWERTZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/05/2006
Last Update Date: 03/31/2021
Certification Date: 03/31/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8361 W 3RD ST SUITE 240-E
LOS ANGELES CA
90048-4312
US

IV. Provider business mailing address

1908 DALTON RD
PALOS VERDES ESTATES CA
90274-2656
US

V. Phone/Fax

Practice location:
  • Phone: 310-854-3400
  • Fax: 310-854-5732
Mailing address:
  • Phone: 310-375-5680
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberG38676
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberG38676
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: