Healthcare Provider Details

I. General information

NPI: 1063589430
Provider Name (Legal Business Name): MICHAEL S. GOLDMAN, M.D., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/29/2006
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16260 VENTURA BLVD SUITE 300
ENCINO CA
91436-2203
US

IV. Provider business mailing address

16260 VENTURA BLVD SUITE 300
ENCINO CA
91436-2203
US

V. Phone/Fax

Practice location:
  • Phone: 818-905-3880
  • Fax: 818-905-7806
Mailing address:
  • Phone: 818-905-3880
  • Fax: 818-905-7806

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA66810
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License NumberA66810
License Number StateCA

VIII. Authorized Official

Name: DR. MICHAEL S. GOLDMAN
Title or Position: DOCTOR
Credential: M.D.
Phone: 818-905-3880