Healthcare Provider Details

I. General information

NPI: 1386814838
Provider Name (Legal Business Name): SVETLANA ARKADYEVNA GORODETSKI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/11/2008
Last Update Date: 03/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 THE CITY DR S ZC 4482
ORANGE CA
92868-3201
US

IV. Provider business mailing address

908 GABRIELINO DR
IRVINE CA
92617-4104
US

V. Phone/Fax

Practice location:
  • Phone: 714-456-5631
  • Fax:
Mailing address:
  • Phone: 626-833-3042
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA99376
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: