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General NPI Number Information
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NPI Number | 1639415227
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Entity Type | Individual
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Provider Name | ELLYN GRACE MCINTOSH M.D.
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Gender | Female
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Dates
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Enumeration Date | 12/31/2012
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Last Update Date | 12/31/2012
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Provider Practice Location Address
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Address Line | 3700 W 190TH ST
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City | TORRANCE
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State | CA
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Zip | 90504-5733
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Country | US
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Telephone | 310-212-4705
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Fax | 310-212-2941
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Provider Business Mailing Address
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Address Line | 3700 W 190TH ST
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City | TORRANCE
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State | CA
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Zip | 90504-5733
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Country | US
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Telephone | 310-212-4705
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Fax | 310-212-2941
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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 | 2083X0100X
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Taxonomy Name | Occupational Medicine Physician
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License Number | G55377
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 2083X0100X
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Taxonomy Name | Occupational Medicine Physician
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License Number | 10280
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License Number State | MT
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Taxonomy #3
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Taxonomy Code | 2083X0100X
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Taxonomy Name | Occupational Medicine Physician
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License Number | ME107354
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License Number State | FL
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Taxonomy #4
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Taxonomy Code | 2083X0100X
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Taxonomy Name | Occupational Medicine Physician
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License Number | 64689
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License Number State | GA
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Taxonomy #5
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Taxonomy Code | 2083X0100X
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Taxonomy Name | Occupational Medicine Physician
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License Number | 27726
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License Number State | OK
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