Provider Demographics
NPI:1124200126
Name:GORELIK, MARTA FAJARDO (MD)
Entity Type:Individual
Prefix:DR
First Name:MARTA
Middle Name:FAJARDO
Last Name:GORELIK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARTA
Other - Middle Name:
Other - Last Name:FAJARDO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 1386
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN BAUTISTA
Mailing Address - State:CA
Mailing Address - Zip Code:95045-1386
Mailing Address - Country:US
Mailing Address - Phone:831-623-4913
Mailing Address - Fax:
Practice Address - Street 1:12 AHWAHNEE STREET
Practice Address - Street 2:
Practice Address - City:SAN JUAN BAUTISTA
Practice Address - State:CA
Practice Address - Zip Code:95045-1386
Practice Address - Country:US
Practice Address - Phone:831-623-4913
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-30
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG77143208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics