Provider Demographics
NPI:1164528741
Name:GELLENS, ANDREW JAY (MD)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:JAY
Last Name:GELLENS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8851 CENTER DR 210
Mailing Address - Street 2:
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91942
Mailing Address - Country:US
Mailing Address - Phone:619-463-7775
Mailing Address - Fax:619-463-4181
Practice Address - Street 1:8851 CENTER DR 210
Practice Address - Street 2:
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942
Practice Address - Country:US
Practice Address - Phone:619-463-7775
Practice Address - Fax:619-463-4181
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2023-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG71477207VX0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0201XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologic Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GR0043610OtherMEDICAL GROUP
WG71477AMedicare ID - Type Unspecified
F64412Medicare UPIN
W11010Medicare ID - Type Unspecified