=====================================================
General NPI Number Information
=====================================================
NPI Number | 1699861526
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | GRETCHEN ANN HETZLER M.D..
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/05/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10861 CHERRY ST SUITE 300
-----------------------------------------------------
City | LOS ALAMITOS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90720-5402
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 562-594-8320
-----------------------------------------------------
Fax | 562-594-9757
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10861 CHERRY ST SUITE 300
-----------------------------------------------------
City | LOS ALAMITOS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90720-5402
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 562-594-8320
-----------------------------------------------------
Fax | 562-594-9757
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207VG0400X
-----------------------------------------------------
Taxonomy Name | Gynecology Physician
-----------------------------------------------------
License Number | G58400
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------