Healthcare Provider Details

I. General information

NPI: 1669729869
Provider Name (Legal Business Name): SONJA NICOLE GOLDBERG MPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/07/2012
Last Update Date: 04/20/2022
Certification Date: 04/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 PARNASSUS AVE # A-68
SAN FRANCISCO CA
94143-2202
US

IV. Provider business mailing address

1350 SANCHEZ ST
SAN FRANCISCO CA
94131-2054
US

V. Phone/Fax

Practice location:
  • Phone: 415-353-1756
  • Fax:
Mailing address:
  • Phone: 925-997-9638
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number28380
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number60975
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: