Healthcare Provider Details

I. General information

NPI: 1376707711
Provider Name (Legal Business Name): MYTIEN GOLDBERG M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/15/2008
Last Update Date: 06/07/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2808 COLUMBIA ST
TORRANCE CA
90503-3808
US

IV. Provider business mailing address

2808 COLUMBIA STREET
TORRANCE CA
90503
US

V. Phone/Fax

Practice location:
  • Phone: 310-618-9922
  • Fax: 310-618-8445
Mailing address:
  • Phone: 310-618-9922
  • Fax: 310-618-8445

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2082S0105X
TaxonomySurgery of the Hand (Plastic Surgery) Physician
License NumberA80676
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: