Healthcare Provider Details

I. General information

NPI: 1861768996
Provider Name (Legal Business Name): VANESSA KATYA GOLDENBERG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2012
Last Update Date: 05/08/2020
Certification Date: 05/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8900 N KENDALL DR
MIAMI FL
33176-2118
US

IV. Provider business mailing address

9064 ABBOTT AVE
SURFSIDE FL
33154-3236
US

V. Phone/Fax

Practice location:
  • Phone: 786-596-6944
  • Fax:
Mailing address:
  • Phone: 305-310-1480
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number293700
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberME143578
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: