1417049156 NPI number — YARA CHRISTINA ROTHERMEL GORSKI M.D.

Table of content: TAMARA S HERMANSON P.T. (NPI 1083661540)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417049156 NPI number — YARA CHRISTINA ROTHERMEL GORSKI M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROTHERMEL GORSKI
Provider First Name:
YARA
Provider Middle Name:
CHRISTINA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1417049156
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/10/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
31537 INLAND VALLEY DR
Provider Second Line Business Mailing Address:
SUITE 202
Provider Business Mailing Address City Name:
TEMECULA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92592
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
951-698-3000
Provider Business Mailing Address Fax Number:
951-698-7700

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
31537 INLAND VALLEY DR
Provider Second Line Business Practice Location Address:
SUITE 202
Provider Business Practice Location Address City Name:
TEMECULA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92592
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
951-698-3000
Provider Business Practice Location Address Fax Number:
951-698-7700
Provider Enumeration Date:
09/29/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208600000X , with the licence number:  A681540 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2086S0129X , with the licence number: A068154 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: CJ959C . This is a "MEDICARE PTAN" identifier . This identifiers is of the category "OTHER".




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