Healthcare Provider Details

I. General information

NPI: 1548216674
Provider Name (Legal Business Name): GWENERVERE LOUISE FLAGG M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

Provider Other Name: GWEN FLAGG M.D.

II. Dates (important events)

Enumeration Date: 05/26/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

231 W VERNON AVE SUITE 204
LOS ANGELES CA
90037-2700
US

IV. Provider business mailing address

PO BOX 91177
LOS ANGELES CA
90009-1177
US

V. Phone/Fax

Practice location:
  • Phone: 323-234-9595
  • Fax: 323-234-9588
Mailing address:
  • Phone: 323-234-9595
  • Fax: 323-234-9588

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code204F00000X
TaxonomyTransplant Surgery Physician
License NumberG42472
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberG42472
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberG42472
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: