1215010962 NPI number — DAVID NATHAN GOLDSTEIN MD

Table of content: DAVID NATHAN GOLDSTEIN MD (NPI 1215010962)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215010962 NPI number — DAVID NATHAN GOLDSTEIN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GOLDSTEIN
Provider First Name:
DAVID
Provider Middle Name:
NATHAN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1215010962
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/18/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
50 DOUGLAS DRIVE SUITE 391
Provider Second Line Business Mailing Address:
HEALTH SERVICES ADMINISTRATION
Provider Business Mailing Address City Name:
MARTINEZ
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94553-4098
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
925-957-5429
Provider Business Mailing Address Fax Number:
925-957-5401

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2500 ALHAMBRA AVENUE
Provider Second Line Business Practice Location Address:
CONTRA COSTA RIGIONAL MEDICAL CENTER AND HEALTH CENTERS
Provider Business Practice Location Address City Name:
MARTINEZ
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94553-3156
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
925-370-5110
Provider Business Practice Location Address Fax Number:
925-370-5142
Provider Enumeration Date:
10/23/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207P00000X , with the licence number:  G75368 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)