Provider Demographics
NPI:1417010182
Name:GURSKIS, JOHN RONALD (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:RONALD
Last Name:GURSKIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9949 SAGE CIR
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-2327
Mailing Address - Country:US
Mailing Address - Phone:562-688-1700
Mailing Address - Fax:714-839-0667
Practice Address - Street 1:10840 WARNER AVE
Practice Address - Street 2:SUITE 109
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-3847
Practice Address - Country:US
Practice Address - Phone:714-962-3661
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG050055174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA51551Medicare UPIN