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General NPI Number Information
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NPI Number | 1457574519
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Entity Type | Organization
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Legal Business Name | NORCROSS FAMILY MEDICINE, INC.
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Dates
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Enumeration Date | 04/10/2007
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Last Update Date | 11/05/2019
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Provider Practice Location Address
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Address Line | 65A PENINSULA CENTER
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City | ROLLING HILLS ESTATES
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State | CA
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Zip | 90274-3808
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Country | US
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Telephone | 310-541-8919
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Fax |
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Provider Business Mailing Address
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Address Line | 65A PENINSULA CTR
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City | ROLLING HILLS ESTATES
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State | CA
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Zip | 90274-3506
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Country | US
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Telephone | 310-541-8919
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. GWENNE NORCROSS
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Credential | D.O.
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Telephone | 310-541-8919
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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