Healthcare Provider Details

I. General information

NPI: 1083779771
Provider Name (Legal Business Name): CARYN B GOLDMAN L.AC., R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/24/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2881 CASTRO VALLEY BLVD STE Q
CASTRO VALLEY CA
94546-5566
US

IV. Provider business mailing address

4162 PARK BLVD
OAKLAND CA
94602-1207
US

V. Phone/Fax

Practice location:
  • Phone: 510-727-1238
  • Fax: 925-803-5001
Mailing address:
  • Phone: 510-727-1238
  • Fax: 925-803-5001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC 4530
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: