Provider Demographics
NPI:1972608438
Name:NORCROSS, GWENNE NOEL (DO)
Entity Type:Individual
Prefix:DR
First Name:GWENNE
Middle Name:NOEL
Last Name:NORCROSS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65A PENUNSULA CENTER
Mailing Address - Street 2:
Mailing Address - City:ROLLING HILLS ESTATES
Mailing Address - State:CA
Mailing Address - Zip Code:90274
Mailing Address - Country:US
Mailing Address - Phone:310-541-8919
Mailing Address - Fax:310-541-8959
Practice Address - Street 1:65A PENINSULA CENTER
Practice Address - Street 2:
Practice Address - City:ROLLING HILLS ESTATES
Practice Address - State:CA
Practice Address - Zip Code:90277
Practice Address - Country:US
Practice Address - Phone:310-541-8919
Practice Address - Fax:310-541-8959
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2011-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A9825207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW21153Medicare PIN
CAW20A9825AMedicare PIN