Healthcare Provider Details

I. General information

NPI: 1669411542
Provider Name (Legal Business Name): LAURENCE K GORLICK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2006
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40500 PAXTON DR
RANCHO MIRAGE CA
92270-3504
US

IV. Provider business mailing address

40500 PAXTON DR
RANCHO MIRAGE CA
92270-3504
US

V. Phone/Fax

Practice location:
  • Phone: 310-713-7002
  • Fax: 760-501-2953
Mailing address:
  • Phone: 310-713-7002
  • Fax: 760-501-2953

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA36580
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License NumberA36580
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: