MEDICARE: DR. KENDRA FLEAGLE GORLITSKY MD

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	207Q00000X	Family Medicine Physician	G61804	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	WG61804B	OTHER		PPIN

General Provider Information

NPI Number	:	1902992134
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KENDRA FLEAGLE GORLITSKY MD

Provider Business Mailing Address
First Line	:	12408 DEERBROOK LANE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90049-1912
Country	:	US
Telephone Number	:	310-471-4030
Fax Number	:

Provider Business Practice Location Address
First Line	:	123 S ALVARADO STREET
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90057-2201
Country	:	US
Telephone Number	:	213-989-7700
Fax Number	:	213-989-7702

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

Provider Enumeration Date	:	10/05/2006
Last Update Date	:	04/23/2025

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