MEDICARE: GRETCHEN A RONQUILLO NP

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	363L00000X	Nurse Practitioner	95031519	CA

General Provider Information

NPI Number	:	1679303184
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GRETCHEN A RONQUILLO NP

Provider Business Mailing Address
First Line	:	8370 WILSHIRE BLVD
Second Line	:
City	:	BEVERLY HILLS
State	:	CA
Zip	:	90211-2333
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8370 WILSHIRE BLVD
Second Line	:
City	:	BEVERLY HILLS
State	:	CA
Zip	:	90211-2333
Country	:	US
Telephone Number	:	323-966-0000
Fax Number	:

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

Provider Enumeration Date	:	08/07/2024
Last Update Date	:	12/02/2024

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