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Individual

JOHN RUSSELL GORNY

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
665 CAMINO DE LOS MARES, SUITE 203A, SAN CLEMENTE, CA 92673-2859
(949) 661-3101
(949) 661-2865
Mailing address
665 CAMINO DE LOS MARES, SUITE 203A, SAN CLEMENTE, CA 92673-2859
(949) 661-3101
(949) 661-2865

Taxonomy

Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
G12635
CA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
953607067
TAX ID
CA
05
OOG126350
CA
Enumeration date
02/19/2007
Last updated
03/07/2023
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