Healthcare Provider Details

I. General information

NPI: 1972534238
Provider Name (Legal Business Name): LEONARD IRWIN GOLDSTEIN M.D. F.A.C.P.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 07/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 UCLA MEDICAL PLZ SUITE 240
LOS ANGELES CA
90024-6970
US

IV. Provider business mailing address

PO BOX 7247
SANTA MONICA CA
90406-7247
US

V. Phone/Fax

Practice location:
  • Phone: 310-208-2355
  • Fax: 310-824-2781
Mailing address:
  • Phone: 310-442-2113
  • Fax: 310-442-9596

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberG16659
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207RI0008X
TaxonomyHepatology Physician
License NumberG16659
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: