Basic Information
| Provider Information | |||||||||
| NPI: | 1386814838 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GORODETSKI | ||||||||
| FirstName: | SVETLANA | ||||||||
| MiddleName: | ARKADYEVNA | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 908 GABRIELINO DR | ||||||||
| Address2: | |||||||||
| City: | IRVINE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926174104 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6268333042 | ||||||||
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| Practice Location | |||||||||
| Address1: | 101 THE CITY DR S | ||||||||
| Address2: | ZC 4482 | ||||||||
| City: | ORANGE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 928683201 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7144565631 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/11/2008 | ||||||||
| LastUpdateDate: | 03/11/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | A99376 | CA | Y | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.