Healthcare Provider Details

I. General information

NPI: 1639300940
Provider Name (Legal Business Name): MICHAEL I. GORAN PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/04/2009
Last Update Date: 08/04/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2250 ALCAZAR ST. CSC 200
LOS ANGELES CA
90033-9073
US

IV. Provider business mailing address

2250 ALCAZAR ST. CSC 200
LOS ANGELES CA
90033-9073
US

V. Phone/Fax

Practice location:
  • Phone: 323-442-3027
  • Fax: 323-442-4103
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1744R1102X
TaxonomyResearch Study Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: