Provider Demographics
NPI:1508052432
Name:CHEN, GRETCHEN M (MD)
Entity Type:Individual
Prefix:
First Name:GRETCHEN
Middle Name:M
Last Name:CHEN
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 1:11835 CARMEL MOUNTAIN RD
Mailing Address - Street 2:SUITE 1304-347
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92128-4609
Mailing Address - Country:US
Mailing Address - Phone:858-376-7701
Mailing Address - Fax:
Practice Address - Street 1:11835 CARMEL MOUNTAIN RD
Practice Address - Street 2:SUITE 1304-347
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92128-4609
Practice Address - Country:US
Practice Address - Phone:858-376-7701
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-25
Last Update Date:2010-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA95595208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation