MEDICARE: STELLA GORDIENKO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker

General Provider Information

NPI Number	:	1093893208
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STELLA GORDIENKO

Provider Business Mailing Address
First Line	:	444 PIEDMONT AVE UNIT 201
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91206-6114
Country	:	US
Telephone Number	:	626-229-3872
Fax Number	:

Provider Business Practice Location Address
First Line	:	532 E COLORADO BLVD
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91101-2044
Country	:	US
Telephone Number	:	626-229-3872
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/02/2006
Last Update Date	:	07/08/2007

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Directions to “ STELLA GORDIENKO ” Practice Location

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