Provider Demographics
NPI:1518166073
Name:GORBACHOVA, TETYANA A (MD)
Entity Type:Individual
Prefix:
First Name:TETYANA
Middle Name:A
Last Name:GORBACHOVA
Suffix:
Gender:F
Credentials:MD
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Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9330 JAMISON AVE
Mailing Address - Street 2:UNIT B
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19115-4277
Mailing Address - Country:US
Mailing Address - Phone:267-251-5631
Mailing Address - Fax:
Practice Address - Street 1:3350 LA JOLLA VILLAGE DR
Practice Address - Street 2:114 - BONEPIT
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92161-0002
Practice Address - Country:US
Practice Address - Phone:858-642-3343
Practice Address - Fax:858-552-7565
Is Sole Proprietor?:No
Enumeration Date:2007-07-15
Last Update Date:2007-07-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA946572085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology