MEDICARE: GRETCHEN M CHEN MD

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	208100000X	Physical Medicine & Rehabilitation Physician	A95595	CA

General Provider Information

NPI Number	:	1508052432
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GRETCHEN M CHEN MD

Provider Business Mailing Address
First Line	:	11835 CARMEL MOUNTAIN RD
Second Line	:	SUITE 1304-347
City	:	SAN DIEGO
State	:	CA
Zip	:	92128-4609
Country	:	US
Telephone Number	:	858-376-7701
Fax Number	:

Provider Business Practice Location Address
First Line	:	11835 CARMEL MOUNTAIN RD
Second Line	:	SUITE 1304-347
City	:	SAN DIEGO
State	:	CA
Zip	:	92128-4609
Country	:	US
Telephone Number	:	858-376-7701
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/25/2007
Last Update Date	:	08/06/2010

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