Healthcare Provider Details

I. General information

NPI: 1104989649
Provider Name (Legal Business Name): ROBERT DAVID GOLDMAN MD.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: ROBERT DAVID GOLDMAN M. D.

II. Dates (important events)

Enumeration Date: 12/18/2006
Last Update Date: 06/07/2024
Certification Date: 06/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23929 MCBEAN PKWY
VALENCIA CA
91355-4466
US

IV. Provider business mailing address

PO BOX 9602
MISSION HILLS CA
91346-9602
US

V. Phone/Fax

Practice location:
  • Phone: 661-290-5330
  • Fax: 661-290-5331
Mailing address:
  • Phone: 818-837-5637
  • Fax: 818-837-5589

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License Number19681
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License NumberG44889
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: