Healthcare Provider Details

I. General information

NPI: 1104562750
Provider Name (Legal Business Name): SL GOLDBERG MD A MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/06/2022
Last Update Date: 05/06/2022
Certification Date: 05/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

880 CASS ST STE 108
MONTEREY CA
93940-2948
US

IV. Provider business mailing address

867 VIA MIRADA
MONTEREY CA
93940-4615
US

V. Phone/Fax

Practice location:
  • Phone: 831-649-9330
  • Fax: 831-649-9335
Mailing address:
  • Phone: 206-734-8882
  • Fax: 831-649-9335

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. STEVEN L GOLDBERG
Title or Position: PHYSICIAN
Credential: MD
Phone: 206-734-8882