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General NPI Number Information
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NPI Number | 1386938082
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Entity Type | Individual
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Provider Name | MATTHEW GOLDENBERG D.O.
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Gender | Male
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Dates
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Enumeration Date | 05/31/2011
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Last Update Date | 04/24/2020
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Provider Practice Location Address
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Address Line | 2515 WILSHIRE BLVD
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City | SANTA MONICA
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State | CA
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Zip | 90403-4615
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Country | US
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Telephone | 888-502-2120
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Fax | 888-502-2120
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Provider Business Mailing Address
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Address Line | 2708 WILSHIRE BLVD # 461
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City | SANTA MONICA
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State | CA
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Zip | 90403-4706
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Country | US
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Telephone | 424-276-0777
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Fax | 888-502-2120
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084A0401X
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Taxonomy Name | Addiction Medicine (Psychiatry & Neurology) Physician
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License Number | 145695
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License Number State | AK
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Taxonomy #2
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Taxonomy Code | 2084A0401X
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Taxonomy Name | Addiction Medicine (Psychiatry & Neurology) Physician
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License Number | 20A13416
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 145695
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License Number State | AK
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Taxonomy #4
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 20A13416
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License Number State | CA
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