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NPI Code Detail

MEDICARE: DR. DIVESH GOEL MD

MEDICARE: DR. DIVESH GOEL MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208M00000XHospitalist PhysicianA178405CA
2207Q00000XFamily Medicine PhysicianA178405CA

General Provider Information

NPI Number : 1578026050
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. DIVESH GOEL MD
Provider Business Mailing Address
First Line : 512 ESPLANADE APT 101
Second Line :
City : REDONDO BEACH
State : CA
Zip : 90277-4063
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 512 ESPLANADE APT 101
Second Line :
City : REDONDO BEACH
State : CA
Zip : 90277-4063
Country : US
Telephone Number : 310-951-2894
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/10/2019
Last Update Date : 01/20/2026

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