Healthcare Provider Details

I. General information

NPI: 1902910649
Provider Name (Legal Business Name): ASHER RAPHAEL GORELIK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2006
Last Update Date: 06/18/2024
Certification Date: 06/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4540 KEARNY VILLA RD STE 103
SAN DIEGO CA
92123-1564
US

IV. Provider business mailing address

4540 KEARNY VILLA RD STE 103
SAN DIEGO CA
92123-1564
US

V. Phone/Fax

Practice location:
  • Phone: 858-279-1223
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberME 40538
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License NumberME 40538
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberG88993
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: