Healthcare Provider Details

I. General information

NPI: 1821064684
Provider Name (Legal Business Name): MARK A GOLDBERG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/23/2006
Last Update Date: 06/03/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21840 NORMANDIE AVE STE. 700
TORRANCE CA
90502-2047
US

IV. Provider business mailing address

21840 NORMANDIE AVE STE. 700
TORRANCE CA
90502-2047
US

V. Phone/Fax

Practice location:
  • Phone: 310-222-5101
  • Fax: 310-320-5463
Mailing address:
  • Phone: 310-222-5101
  • Fax: 310-320-5463

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberG20699
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: