Gorodetsky, Jaqueline Alexis

Gorodetsky, Jaqueline Alexis is an sole proprietor health care provider with primary practice located at 499 Pesaro St , Oak Park CA 91377-4838. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Psychiatric/Mental Health, which is considered as her primary health care specialty. Gorodetsky, Jaqueline Alexis can be contacted via phone (323) 842-6860.

Contact Information

Primary practice address
499 Pesaro St Oak Park CA 91377-4838
Phone: (323) 842-6860
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Psychiatric/Mental Health 363LP0808X 95027727 California

Profile Details

NPI number 1619730660
LBN Legal business name Gorodetsky, Jaqueline Alexis
Credentials
Entity Individual
Sole proprietor 1 Yes
Enumeration date Feb 2nd, 2024
Last updated Feb 2nd, 2024 - about 2 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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