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General NPI Number Information
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NPI Number | 1336656503
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Entity Type | Organization
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Legal Business Name | SHERMAN OAKS MEDICAL ASSOCIATES A PROF CORP
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Dates
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Enumeration Date | 01/09/2018
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Last Update Date | 01/09/2018
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Provider Practice Location Address
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Address Line | 15476 VENTURA BLVD STE A
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City | SHERMAN OAKS
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State | CA
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Zip | 91403-3002
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Country | US
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Telephone | 747-998-5300
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Fax | 747-998-5277
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Provider Business Mailing Address
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Address Line | 15476 VENTURA BLVD STE A
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City | SHERMAN OAKS
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State | CA
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Zip | 91403-3002
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Country | US
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Telephone | 747-998-5300
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Fax | 747-998-5277
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. RICHARD MARK GOLDSTEIN
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Credential | M.D.
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Telephone | 747-998-5300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QG0300X
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Taxonomy Name | Geriatric Medicine (Family Medicine) Physician
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License Number | A31044
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License Number State | CA
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