Healthcare Provider Details

I. General information

NPI: 1669493375
Provider Name (Legal Business Name): MARK GELLMAN DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2006
Last Update Date: 02/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22411 HAWTHORNE BLVD
TORRANCE CA
90505-2507
US

IV. Provider business mailing address

1223 WILSHIRE BLVD # 193
SANTA MONICA CA
90403-5406
US

V. Phone/Fax

Practice location:
  • Phone: 310-784-3740
  • Fax: 310-375-1392
Mailing address:
  • Phone: 310-947-1882
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number20A8207
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: