Healthcare Provider Details
I. General information
NPI: 1942409487
Provider Name (Legal Business Name): BARBARA GOLDSTEIN CO, CFOM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y
II. Dates (important events)
Enumeration Date: 07/14/2007
Last Update Date: 01/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:
III. Provider practice location address
5350 N 16 ST 101
PHOENIX AZ
85016-3213
US
IV. Provider business mailing address
PO BOX 10316
PHOENIX AZ
85064-0316
US
V. Phone/Fax
- Phone: 602-234-9568
- Fax: 602-957-2562
- Phone: 602-234-9568
- Fax: 602-957-2562
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 335E00000X |
| Taxonomy | Prosthetic/Orthotic Supplier |
| License Number | |
| License Number State | |
VIII. Authorized Official
Name:
Title or Position:
Credential:
Phone: