Provider Demographics
NPI:1417049156
Name:ROTHERMEL GORSKI, YARA CHRISTINA (MD)
Entity Type:Individual
Prefix:
First Name:YARA
Middle Name:CHRISTINA
Last Name:ROTHERMEL GORSKI
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 1:31537 INLAND VALLEY DR
Mailing Address - Street 2:SUITE 202
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92592
Mailing Address - Country:US
Mailing Address - Phone:951-698-3000
Mailing Address - Fax:951-698-7700
Practice Address - Street 1:31537 INLAND VALLEY DR
Practice Address - Street 2:SUITE 202
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92592
Practice Address - Country:US
Practice Address - Phone:951-698-3000
Practice Address - Fax:951-698-7700
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-29
Last Update Date:2015-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA681540208600000X
CAA0681542086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CJ959COtherMEDICARE PTAN