Provider Demographics
NPI:1699861526
Name:HETZLER, GRETCHEN ANN (MD)
Entity type:Individual
Prefix:DR
First Name:GRETCHEN
Middle Name:ANN
Last Name:HETZLER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10861 CHERRY ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:LOS ALAMITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90720-5402
Mailing Address - Country:US
Mailing Address - Phone:562-594-8320
Mailing Address - Fax:562-594-9757
Practice Address - Street 1:10861 CHERRY ST
Practice Address - Street 2:SUITE 300
Practice Address - City:LOS ALAMITOS
Practice Address - State:CA
Practice Address - Zip Code:90720-5402
Practice Address - Country:US
Practice Address - Phone:562-594-8320
Practice Address - Fax:562-594-9757
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG58400207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF60698Medicare UPIN
CAW18253Medicare ID - Type Unspecified