1316067085 NPI number — CARMEN L GOLDENBERG RNP

Table of content: CARMEN L GOLDENBERG RNP (NPI 1316067085)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316067085 NPI number — CARMEN L GOLDENBERG RNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GOLDENBERG
Provider First Name:
CARMEN
Provider Middle Name:
L
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
RNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1316067085
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
48 BERLAMO
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RANCHO SANTA MARGARITA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92688-2657
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
949-459-0548
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4870 BARRANCA PKWY
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
IRVINE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92604-4709
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
949-559-4870
Provider Business Practice Location Address Fax Number:
949-559-5638
Provider Enumeration Date:
03/29/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LW0102X , with the licence number:  RN 428773 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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