Healthcare Provider Details

I. General information

NPI: 1295811990
Provider Name (Legal Business Name): JUDY GOLDSTEIN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4355 RUFFIN RD
SAN DIEGO CA
92123-4306
US

IV. Provider business mailing address

1166 SIERRA LINDA DR
ESCONDIDO CA
92025-7642
US

V. Phone/Fax

Practice location:
  • Phone: 858-576-2957
  • Fax:
Mailing address:
  • Phone: 858-576-2957
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0008X
TaxonomyPediatric Neurodevelopmental Disabilities Physician
License NumberG17671
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: