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General NPI Number Information
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NPI Number | 1396259362
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Entity Type | Organization
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Legal Business Name | RONALD K GOLDBERG MD INC
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Dates
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Enumeration Date | 11/28/2017
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Last Update Date | 11/28/2017
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Provider Practice Location Address
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Address Line | 5565 GROSSMONT CENTER DR STE 455
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City | LA MESA
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State | CA
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Zip | 91942-3073
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Country | US
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Telephone | 619-462-9353
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Fax | 619-462-6935
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Provider Business Mailing Address
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Address Line | 5565 GROSSMONT CENTER DR STE 455
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City | LA MESA
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State | CA
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Zip | 91942-3073
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Country | US
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Telephone | 619-462-9353
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Fax | 619-462-6935
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Authorized Official
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Title or Position | PRACTICE ADMINISTRATOR
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Name | JENNIFER HANSEN
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Credential |
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Telephone | 619-462-9353
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | G65437
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License Number State | CA
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