MEDICARE: NORCROSS FAMILY MEDICINE, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1457574519
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORCROSS FAMILY MEDICINE, INC.

Provider Business Mailing Address
First Line	:	65A PENINSULA CTR
Second Line	:
City	:	ROLLING HILLS ESTATES
State	:	CA
Zip	:	90274-3506
Country	:	US
Telephone Number	:	310-541-8919
Fax Number	:

Provider Business Practice Location Address
First Line	:	65A PENINSULA CENTER
Second Line	:
City	:	ROLLING HILLS ESTATES
State	:	CA
Zip	:	90274-3808
Country	:	US
Telephone Number	:	310-541-8919
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. GWENNE NORCROSS
Credential	:	D.O.
Telephone Number	:	310-541-8919

Provider Enumeration Date	:	04/10/2007
Last Update Date	:	11/05/2019

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