Healthcare Provider Details

I. General information

NPI: 1881281822
Provider Name (Legal Business Name): DR. SERENA GOLDSTEIN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/23/2020
Last Update Date: 12/23/2020
Certification Date: 12/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3575 FILLMORE ST APT 201
SAN FRANCISCO CA
94123-2136
US

IV. Provider business mailing address

3575 FILLMORE ST APT 201
SAN FRANCISCO CA
94123-2136
US

V. Phone/Fax

Practice location:
  • Phone: 646-450-1704
  • Fax:
Mailing address:
  • Phone: 646-450-1704
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number1220
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: