1477626950 NPI number — GOLDBERG STRAZNICKA INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477626950 NPI number — GOLDBERG STRAZNICKA INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GOLDBERG STRAZNICKA INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1477626950
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/21/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
175 LENNON LN STE 100
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WALNUT CREEK
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94598-2466
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
925-296-7155
Provider Business Mailing Address Fax Number:
925-296-7174

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1515 YGNACIO VALLEY RD STE A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WALNUT CREEK
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94598-3005
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
925-296-7155
Provider Business Practice Location Address Fax Number:
925-296-7174
Provider Enumeration Date:
11/15/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
STRAZNICKA
Authorized Official First Name:
MICHAELA
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
925-296-1755

Provider Taxonomy Codes

  • Taxonomy code: 208G00000X , with the licence number:  A72635 , 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)