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General NPI Number Information
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NPI Number | 1730405267
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Entity Type | Organization
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Legal Business Name | ELLIE JC GOLDSTEIN MD INC
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Dates
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Enumeration Date | 04/08/2010
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Last Update Date | 04/11/2018
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Provider Practice Location Address
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Address Line | 2021 SANTA MONICA BLVD 740 E
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City | SANTA MONICA
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State | CA
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Zip | 90404-2208
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Country | US
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Telephone | 310-315-1511
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Fax | 310-315-3662
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Provider Business Mailing Address
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Address Line | 2021 SANTA MONICA BLVD 740 E
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City | SANTA MONICA
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State | CA
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Zip | 90404-2208
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Country | US
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Telephone | 310-315-1511
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Fax | 310-315-3662
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ELLIE JC GOLDSTEIN MD INC
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Credential | M.D.
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Telephone | 310-315-1511
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RI0200X
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Taxonomy Name | Infectious Disease Physician
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License Number | G30475
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License Number State | CA
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