Provider Demographics
NPI:1679558035
Name:GAW GONZALO, IRENE TAN (MD)
Entity Type:Individual
Prefix:DR
First Name:IRENE
Middle Name:TAN
Last Name:GAW GONZALO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:301 W HUNTINGTON DR
Mailing Address - Street 2:SUITE 212
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91007-3462
Mailing Address - Country:US
Mailing Address - Phone:626-821-5300
Mailing Address - Fax:626-821-0993
Practice Address - Street 1:301 W HUNTINGTON DR
Practice Address - Street 2:SUITE 212
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91007-3462
Practice Address - Country:US
Practice Address - Phone:626-821-5300
Practice Address - Fax:626-821-0993
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA64475207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWA64475OtherPPIN
CAWA64475OtherPPIN
CAH494201Medicare UPIN