Healthcare Provider Details

I. General information

NPI: 1447990411
Provider Name (Legal Business Name): ELYSSA GOLDSTEIN DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2022
Last Update Date: 03/29/2022
Certification Date: 03/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10099 RIDGEGATE PKWY STE 200
LONE TREE CO
80124-5532
US

IV. Provider business mailing address

7171 S CHEROKEE TRL APT 1834
AURORA CO
80016-2295
US

V. Phone/Fax

Practice location:
  • Phone: 720-874-2411
  • Fax:
Mailing address:
  • Phone: 317-407-6516
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: