Healthcare Provider Details

I. General information

NPI: 1316017346
Provider Name (Legal Business Name): SEYMOUR F GORELICK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 06/01/2024
Certification Date: 06/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 BLUE LAGOON
LAGUNA BEACH CA
92651-4214
US

IV. Provider business mailing address

2 BLUE LAGOON
LAGUNA BEACH CA
92651-4214
US

V. Phone/Fax

Practice location:
  • Phone: 818-216-0237
  • Fax:
Mailing address:
  • Phone: 818-216-0237
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License NumberG32400
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License NumberG32400
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License NumberG32400
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberG32400
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: