Healthcare Provider Details

I. General information

NPI: 1609171933
Provider Name (Legal Business Name): LEONARD S. GOLDBERG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2011
Last Update Date: 03/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3737 SAN DIMAS ST SUITE 101
BAKERSFIELD CA
93301-5732
US

IV. Provider business mailing address

3737 SAN DIMAS ST SUITE 101
BAKERSFIELD CA
93301-5732
US

V. Phone/Fax

Practice location:
  • Phone: 661-327-5037
  • Fax: 661-327-7633
Mailing address:
  • Phone: 661-327-5037
  • Fax: 661-327-7633

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License NumberC26721
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: