Healthcare Provider Details

I. General information

NPI: 1518144658
Provider Name (Legal Business Name): SARAH JULIA GOLDBERG NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/30/2008
Last Update Date: 01/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 MEDICAL PLAZA SUITE 365
LOS ANGELES CA
90095-0001
US

IV. Provider business mailing address

200 MEDICAL PLAZA SUITE 365
LOS ANGELES CA
90095-0001
US

V. Phone/Fax

Practice location:
  • Phone: 310-301-8708
  • Fax: 310-301-8751
Mailing address:
  • Phone: 310-301-8708
  • Fax: 310-301-8751

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number608924
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number16694
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number16694
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: