Healthcare Provider Details

I. General information

NPI: 1437391554
Provider Name (Legal Business Name): AMY GELFAND D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2009
Last Update Date: 04/03/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1027 PRINCETON ST
SANTA MONICA CA
90403-4701
US

IV. Provider business mailing address

1027 PRINCETON ST
SANTA MONICA CA
90403-4701
US

V. Phone/Fax

Practice location:
  • Phone: 310-453-8633
  • Fax:
Mailing address:
  • Phone: 310-453-8633
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20A 6706
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: