Provider Demographics
NPI:1487849238
Name:GRETCHEN A HETZLER MD INCORPORATED
Entity Type:Organization
Organization Name:GRETCHEN A HETZLER MD INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GRETCHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:HETZLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:562-594-8320
Mailing Address - Street 1:10861 CHERRY ST STE 105
Mailing Address - Street 2:
Mailing Address - City:LOS ALAMITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90720-5403
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-13
Last Update Date:2023-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG058400207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF60698Medicare UPIN
CAW18253Medicare PIN