Healthcare Provider Details

I. General information

NPI: 1851849863
Provider Name (Legal Business Name): PALMDALE MEDICAL CLINIC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2016
Last Update Date: 09/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

540 W PALMDALE BLVD SUITE B
PALMDALE CA
93551-4232
US

IV. Provider business mailing address

540 W PALMDALE BLVD SUITE B
PALMDALE CA
93551-4232
US

V. Phone/Fax

Practice location:
  • Phone: 661-947-5600
  • Fax: 661-947-5900
Mailing address:
  • Phone: 661-947-5600
  • Fax: 661-947-5900

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA102339
License Number StateCA

VIII. Authorized Official

Name: SVETLANA V GORELIKOVA
Title or Position: OWNER
Credential: M.D.
Phone: 661-947-5600