Healthcare Provider Details

I. General information

NPI: 1346439288
Provider Name (Legal Business Name): ELIZABETH ANN IRWIN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MRS. ELIZABETH ANN DENIS

II. Dates (important events)

Enumeration Date: 10/16/2007
Last Update Date: 02/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 DAPPLEGRAY LN
ROLLING HILLS ESTATES CA
90274-4211
US

IV. Provider business mailing address

12 DAPPLEGRAY LN
ROLLING HILLS ESTATES CA
90274-4211
US

V. Phone/Fax

Practice location:
  • Phone: 310-530-7416
  • Fax:
Mailing address:
  • Phone: 310-530-7416
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License NumberG42532
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: