Healthcare Provider Details

I. General information

NPI: 1275347437
Provider Name (Legal Business Name): ELLIOT L GOLDMAN MD A MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2025
Last Update Date: 04/29/2025
Certification Date: 04/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11810 SATICOY ST
NORTH HOLLYWOOD CA
91605-2848
US

IV. Provider business mailing address

PO BOX 7250
SANTA MONICA CA
90406-7250
US

V. Phone/Fax

Practice location:
  • Phone: 310-828-3465
  • Fax: 310-315-0339
Mailing address:
  • Phone: 310-828-3465
  • Fax: 310-315-0339

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: ELLIOT L GOLDMAN
Title or Position: PRESIDENT
Credential: MD
Phone: 310-903-6847