Healthcare Provider Details

I. General information

NPI: 1194214882
Provider Name (Legal Business Name): CARMEL VALLEY NEUROLOGY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2018
Last Update Date: 07/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12264 EL CAMINO REAL STE 303
SAN DIEGO CA
92130
US

IV. Provider business mailing address

3830 VALLEY CENTRE DR STE 705 PMB 423
SAN DIEGO CA
92130-3343
US

V. Phone/Fax

Practice location:
  • Phone: 866-393-9869
  • Fax: 866-393-9868
Mailing address:
  • Phone: 866-393-9869
  • Fax: 866-393-9868

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084S0012X
TaxonomySleep Medicine (Psychiatry & Neurology) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. EDWARD A GOLDBERG
Title or Position: OWNER
Credential: MD
Phone: 866-393-9869