Healthcare Provider Details

I. General information

NPI: 1790940799
Provider Name (Legal Business Name): MARIA LANA GOLDENBERG AU.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2008
Last Update Date: 07/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11733 FOREST PARK LN
CARMEL IN
46033-7223
US

IV. Provider business mailing address

7440 N SHADELAND AVE SUITE 150
INDIANAPOLIS IN
46250-2029
US

V. Phone/Fax

Practice location:
  • Phone: 314-494-4910
  • Fax:
Mailing address:
  • Phone: 317-570-7353
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number2007014907
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: