Healthcare Provider Details

I. General information

NPI: 1629161328
Provider Name (Legal Business Name): HOWARD ROGER GOLDSTINE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 LA VENTA DRIVE #103
WESTLAKE VILLAGE CA
91361
US

IV. Provider business mailing address

1250 LA VENTA DRIVE #103
WESTLAKE VILLAGE CA
91361
US

V. Phone/Fax

Practice location:
  • Phone: 805-495-0841
  • Fax: 805-497-6912
Mailing address:
  • Phone: 805-495-0841
  • Fax: 805-497-6912

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberG22874
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: