Provider Demographics
NPI:1417781873
Name:GOLDMAN, MARGO DEBORAH (RN IBCLC)
Entity type:Individual
Prefix:
First Name:MARGO
Middle Name:DEBORAH
Last Name:GOLDMAN
Suffix:
Gender:F
Credentials:RN IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4346 CAMELLO RD
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91364-4418
Mailing Address - Country:US
Mailing Address - Phone:818-207-1821
Mailing Address - Fax:
Practice Address - Street 1:4346 CAMELLO RD
Practice Address - Street 2:
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91364-4418
Practice Address - Country:US
Practice Address - Phone:818-207-1821
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-28
Last Update Date:2024-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAL-157542163WL0100X
CARN383530163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant