Provider Demographics
NPI:1821089095
Name:REMENCHIK, ELLEN JEAN (MD)
Entity type:Individual
Prefix:DR
First Name:ELLEN
Middle Name:JEAN
Last Name:REMENCHIK
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 1:1801 W OLYMPIC BLVD
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91199-0001
Mailing Address - Country:US
Mailing Address - Phone:323-541-1411
Mailing Address - Fax:
Practice Address - Street 1:2115 N WILMINGTON AVE
Practice Address - Street 2:
Practice Address - City:COMPTON
Practice Address - State:CA
Practice Address - Zip Code:90222-2030
Practice Address - Country:US
Practice Address - Phone:323-541-1411
Practice Address - Fax:323-541-1601
Is Sole Proprietor?:No
Enumeration Date:2005-11-04
Last Update Date:2025-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG8366207R00000X, 2083X0100X
AZ354472083P0500X
CA196118207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No2083P0500XAllopathic & Osteopathic PhysiciansPreventive MedicinePreventive Medicine/Occupational Environmental Medicine
No2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX138384621Medicaid
TX138384615Medicaid
TXP00456696OtherRR MEDICARE
TXTXB116312Medicare PIN