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General NPI Number Information
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NPI Number | 1417010182
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Entity Type | Individual
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Provider Name | JOHN RONALD GURSKIS M.D.
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Gender | Male
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Dates
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Enumeration Date | 12/17/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 10840 WARNER AVE SUITE 109
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City | FOUNTAIN VALLEY
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State | CA
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Zip | 92708-3847
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Country | US
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Telephone | 714-962-3661
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Fax |
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Provider Business Mailing Address
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Address Line | 9949 SAGE CIR
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City | FOUNTAIN VALLEY
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State | CA
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Zip | 92708-2327
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Country | US
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Telephone | 562-688-1700
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Fax | 714-839-0667
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | G050055
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License Number State | CA
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