Healthcare Provider Details

I. General information

NPI: 1306092564
Provider Name (Legal Business Name): MELANIE GOLDFARB MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2008
Last Update Date: 02/13/2024
Certification Date: 11/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2121 SANTA MONICA BLVD
SANTA MONICA CA
90404-2303
US

IV. Provider business mailing address

7660 BEVERLY BLVD APT 247
LOS ANGELES CA
90036-2752
US

V. Phone/Fax

Practice location:
  • Phone: 310-829-8751
  • Fax: 310-315-6113
Mailing address:
  • Phone: 323-865-3535
  • Fax: 323-865-3539

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License NumberA117052
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberA117052
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: