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General NPI Number Information
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NPI Number | 1346559440
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Entity Type | Individual
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Provider Name | GRETCHEN JANE ANDERSEN PA.- C
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Gender | Female
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Dates
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Enumeration Date | 10/07/2010
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Last Update Date | 12/10/2025
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Provider Practice Location Address
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Address Line | 200 N MAIN ST FL 18
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City | LOS ANGELES
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State | CA
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Zip | 90012-4110
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Country | US
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Telephone | 213-978-3800
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Fax |
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Provider Business Mailing Address
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Address Line | 1336 MANHATTAN BEACH BLVD
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City | MANHATTAN BEACH
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State | CA
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Zip | 90266-5232
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Country | US
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Telephone | 818-212-8881
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 014249
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 22195
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License Number State | CA
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