Healthcare Provider Details

I. General information

NPI: 1891117065
Provider Name (Legal Business Name): LIZA GREEN GOLAN MACKINTOSH M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/07/2014
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

136 S EL CALMINO DRIVE
BEVERLY HILLS CA
90212
US

IV. Provider business mailing address

136 S EL CALMINO DRIVE
BEVERLY HILLS CA
90212
US

V. Phone/Fax

Practice location:
  • Phone: 310-400-0889
  • Fax:
Mailing address:
  • Phone: 310-400-0889
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA125596
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: