Healthcare Provider Details

I. General information

NPI: 1023730959
Provider Name (Legal Business Name): BONNI S GOLDSTEIN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2022
Last Update Date: 09/16/2022
Certification Date: 09/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 VIA LA CIMA
RANCHO PALOS VERDES CA
90275-3481
US

IV. Provider business mailing address

10 VIA LA CIMA
RANCHO PALOS VERDES CA
90275-3481
US

V. Phone/Fax

Practice location:
  • Phone: 310-890-2399
  • Fax: 855-411-4420
Mailing address:
  • Phone: 310-890-2399
  • Fax: 855-411-4420

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number074089
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: