Healthcare Provider Details

I. General information

NPI: 1578026050
Provider Name (Legal Business Name): DIVESH GOEL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2019
Last Update Date: 01/20/2026
Certification Date: 01/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

512 ESPLANADE APT 101
REDONDO BEACH CA
90277-4063
US

IV. Provider business mailing address

512 ESPLANADE APT 101
REDONDO BEACH CA
90277-4063
US

V. Phone/Fax

Practice location:
  • Phone: 310-951-2894
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA178405
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberA178405
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: