Jaqueline Alexis Gorodetsky, PMHNP

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

95027727 Issued in CA

Practice address

14860 Roscoe Blvd Ste 307
Panorama City, CA 91402-4691

Phone

(818) 616-2122

NPI assigned

Feb 2, 2024

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2023

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Innovative Medical Solutions Inc a Medical Group

  • Adolescent Medicine (Internal Medicine) Physician
  • Panorama City, CA
  • NPI 1972624955
  Medicare reassignment NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1706832000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1767225600000",
    "number": "1619730660",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14860 ROSCOE BLVD STE 307",
            "city": "PANORAMA CITY",
            "state": "CA",
            "postal_code": "914024691"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14860 ROSCOE BLVD STE 307",
            "city": "PANORAMA CITY",
            "state": "CA",
            "postal_code": "914024691",
            "telephone_number": "818-616-2122"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GORODETSKY",
        "first_name": "JAQUELINE",
        "middle_name": "ALEXIS",
        "credential": "PMHNP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-02-02",
        "last_updated": "2026-01-01",
        "certification_date": "2026-01-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "CA",
            "license": "95027727",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rafael A. Gonzalez, MD
• Good Care Durable Medical Equipment
• Good Day Home Health Care ,Inc.
• Arelys Goodrich
• Eve H. Gordon, MD
• Michael John Goulet, RN, MSN, CNL
• Pollyann Wendy Gowrie-Knox, MD
• Yanina Goykhman, PHARM.D.
• Lorraine Y. Grace, MD
• Yvonne E. Grant, PHARM.D.

• Psychiatric/Mental Health Nurse Practitioner in Panorama City, CA
• Providers in Panorama City, CA by specialty
• Psychiatric/Mental Health Nurse Practitioner in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 1, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.