Provider Demographics
NPI:1386724110
Name:GORODETSKY, GALINA M (MD)
Entity type:Individual
Prefix:
First Name:GALINA
Middle Name:M
Last Name:GORODETSKY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 VAN NESS
Mailing Address - Street 2:710
Mailing Address - City:SF
Mailing Address - State:CA
Mailing Address - Zip Code:94109
Mailing Address - Country:US
Mailing Address - Phone:415-563-8170
Mailing Address - Fax:415-563-8181
Practice Address - Street 1:2000 VAN NESS
Practice Address - Street 2:710
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94109
Practice Address - Country:US
Practice Address - Phone:415-563-8170
Practice Address - Fax:415-563-8181
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2017-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA389162084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A389160Medicaid
CA00A389160Medicaid
CAA28757Medicare UPIN