Healthcare Provider Details

I. General information

NPI: 1124776208
Provider Name (Legal Business Name): DR. ELLEN GOLDSTEIN INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/16/2022
Last Update Date: 03/16/2022
Certification Date: 03/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10390 SANTA MONICA BLVD STE 340
LOS ANGELES CA
90025-6915
US

IV. Provider business mailing address

10390 SANTA MONICA BLVD STE 340
LOS ANGELES CA
90025-6915
US

V. Phone/Fax

Practice location:
  • Phone: 858-216-5402
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License Number
License Number State

VIII. Authorized Official

Name: ELLEN GOLDSTEIN
Title or Position: CEO
Credential: MD
Phone: 904-635-4423