Organization Name: | GLENN I. GOLDBERG, D.O., A PROFESSIONAL MEDICAL CORPORATION |
NPI Number: | 1205051083 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | GLENN I GOLDBERG (OWNER) |
Mailing Address: | 31852 Coast Hwy Suite 300 Laguna Beach |
State: | CA US |
Postal Code: | 926516764 |
Phone Number: | 9494991389 |
Fax Number: | 9494995689 |
NPI Enumeration Date: | 04/16/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 174400000X |
License Number: | 20A5649 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CA |
Taxonomy Type: | Other Service Providers |
Taxonomy Classification: | Specialist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |