Healthcare Provider Details

I. General information

NPI: 1457574519
Provider Name (Legal Business Name): NORCROSS FAMILY MEDICINE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2007
Last Update Date: 11/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

65A PENINSULA CENTER
ROLLING HILLS ESTATES CA
90274-3808
US

IV. Provider business mailing address

65A PENINSULA CTR
ROLLING HILLS ESTATES CA
90274-3506
US

V. Phone/Fax

Practice location:
  • Phone: 310-541-8919
  • Fax:
Mailing address:
  • Phone: 310-541-8919
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. GWENNE NORCROSS
Title or Position: PRESIDENT
Credential: D.O.
Phone: 310-541-8919