Healthcare Provider Details

I. General information

NPI: 1982092755
Provider Name (Legal Business Name): ASHLEY GOLDBERG OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ASHLEY GOLDBERG OTR

II. Dates (important events)

Enumeration Date: 01/02/2015
Last Update Date: 03/23/2026
Certification Date: 03/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4100 NORMAL ST
SAN DIEGO CA
92103-2653
US

IV. Provider business mailing address

301 N ALVARADO APT #107
LOS ANGELES CA
90026
US

V. Phone/Fax

Practice location:
  • Phone: 619-725-5501
  • Fax:
Mailing address:
  • Phone: 561-281-3101
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number14668
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: