Provider Demographics
NPI:1811061369
Name:GORELICK, JOE A (NP)
Entity type:Individual
Prefix:MR
First Name:JOE
Middle Name:A
Last Name:GORELICK
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
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Mailing Address - Street 1:2420 SAMARITAN DR
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95124-3907
Mailing Address - Country:US
Mailing Address - Phone:408-369-5600
Mailing Address - Fax:408-369-5625
Practice Address - Street 1:2420 SAMARITAN DR
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95124-3907
Practice Address - Country:US
Practice Address - Phone:408-369-5600
Practice Address - Fax:408-369-5625
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA11167363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP14680Medicare UPIN
CAZZZ18790ZMedicare ID - Type Unspecified