Healthcare Provider Details

I. General information

NPI: 1316984958
Provider Name (Legal Business Name): RICHARD L GOLDMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2006
Last Update Date: 11/30/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2202 WILSHIRE BLVD
SANTA MONICA CA
90403-5706
US

IV. Provider business mailing address

DEPT LA 21559
PASADENA CA
91185-1559
US

V. Phone/Fax

Practice location:
  • Phone: 310-264-9000
  • Fax: 310-264-9004
Mailing address:
  • Phone: 323-297-0670
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberG37954
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: