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General NPI Number Information
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NPI Number | 1922272103
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Entity Type | Individual
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Provider Name | GRETCHEN LYNN CONROY M.D.
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Gender | Female
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Dates
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Enumeration Date | 04/17/2008
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Last Update Date | 03/02/2020
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Provider Practice Location Address
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Address Line | 24401 CALLE DE LA LOUISA STE 200
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City | LAGUNA HILLS
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State | CA
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Zip | 92653-3624
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Country | US
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Telephone | 499-452-7200
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Fax |
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Provider Business Mailing Address
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Address Line | 500 E 85TH ST #21A
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City | NEW YORK
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State | NY
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Zip | 10028-7405
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Country | US
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Telephone | 312-835-0560
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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 | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 036113582
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License Number State | IL
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