MEDICARE: MS. GWENERVERE LOUISE FLAGG M.D.

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	204F00000X	Transplant Surgery Physician	G42472	CA
2	208600000X	Surgery Physician	G42472	CA
3	208D00000X	General Practice Physician	G42472	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1548216674
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. GWENERVERE LOUISE FLAGG M.D.

Provider Business Mailing Address
First Line	:	PO BOX 91177
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90009-1177
Country	:	US
Telephone Number	:	323-234-9595
Fax Number	:	323-234-9588

Provider Business Practice Location Address
First Line	:	231 W VERNON AVE
Second Line	:	SUITE 204
City	:	LOS ANGELES
State	:	CA
Zip	:	90037-2700
Country	:	US
Telephone Number	:	323-234-9595
Fax Number	:	323-234-9588

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

Provider Enumeration Date	:	05/26/2006
Last Update Date	:	09/11/2025

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Directions to “ MS. GWENERVERE LOUISE FLAGG M.D.” Practice Location

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