Healthcare Provider Details

I. General information

NPI: 1689584963
Provider Name (Legal Business Name): BRAM GOLDSTEIN PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2026
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

699 DIAMOND ST
LAGUNA BEACH CA
92651-3405
US

IV. Provider business mailing address

699 DIAMOND ST
LAGUNA BEACH CA
92651-3405
US

V. Phone/Fax

Practice location:
  • Phone: 949-642-5165
  • Fax: 949-646-7157
Mailing address:
  • Phone: 949-642-5165
  • Fax: 949-646-7157

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: