Provider Demographics
NPI:1245328079
Name:HAWKINS, GENE L (MD)
Entity type:Individual
Prefix:DR
First Name:GENE
Middle Name:L
Last Name:HAWKINS
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 1:400 S SEPULVEDA BLVD STE 260
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90266-6876
Mailing Address - Country:US
Mailing Address - Phone:310-372-4488
Mailing Address - Fax:310-372-4344
Practice Address - Street 1:400 S SEPULVEDA BLVD STE 260
Practice Address - Street 2:
Practice Address - City:MANHATTAN BEACH
Practice Address - State:CA
Practice Address - Zip Code:90266-6876
Practice Address - Country:US
Practice Address - Phone:310-372-4488
Practice Address - Fax:310-372-4344
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG47706208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA92748Medicare UPIN