Provider Demographics
NPI:1154502227
Name:GERTSCH, LORENA LOUIS
Entity Type:Individual
Prefix:MISS
First Name:LORENA
Middle Name:LOUIS
Last Name:GERTSCH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14718 CONDON AVE
Mailing Address - Street 2:
Mailing Address - City:LAWNDALE
Mailing Address - State:CA
Mailing Address - Zip Code:90260-1206
Mailing Address - Country:US
Mailing Address - Phone:310-308-1226
Mailing Address - Fax:
Practice Address - Street 1:14718 CONDON AVE
Practice Address - Street 2:
Practice Address - City:LAWNDALE
Practice Address - State:CA
Practice Address - Zip Code:90260-1206
Practice Address - Country:US
Practice Address - Phone:310-308-1226
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-16
Last Update Date:2007-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1223PO221X1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry