Provider Demographics
NPI:1306942909
Name:ALLEN, GWEN MARIA (MD)
Entity type:Individual
Prefix:DR
First Name:GWEN
Middle Name:MARIA
Last Name:ALLEN
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:1045 W REDONDO BEACH BLVD
Mailing Address - Street 2:#500
Mailing Address - City:GARDENA
Mailing Address - State:CA
Mailing Address - Zip Code:90247-4128
Mailing Address - Country:US
Mailing Address - Phone:310-329-9492
Mailing Address - Fax:310-329-3799
Practice Address - Street 1:1045 W REDONDO BEACH BLVD
Practice Address - Street 2:#500
Practice Address - City:GARDENA
Practice Address - State:CA
Practice Address - Zip Code:90247-4128
Practice Address - Country:US
Practice Address - Phone:310-329-9492
Practice Address - Fax:310-329-3799
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-15
Last Update Date:2008-01-31
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA061790207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A617900Medicaid
CAW17313Medicare ID - Type Unspecified
CA00A617900Medicaid