Provider Demographics
NPI:1962567966
Name:GOLDBERG, DAVID STUART (M D)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:STUART
Last Name:GOLDBERG
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24591 SILVER CLOUD CT
Mailing Address - Street 2:SUITE 150
Mailing Address - City:MONTEREY
Mailing Address - State:CA
Mailing Address - Zip Code:93940-6549
Mailing Address - Country:US
Mailing Address - Phone:831-649-3377
Mailing Address - Fax:831-649-6725
Practice Address - Street 1:24591 SILVER CLOUD CT
Practice Address - Street 2:SUITE 150
Practice Address - City:MONTEREY
Practice Address - State:CA
Practice Address - Zip Code:93940-6549
Practice Address - Country:US
Practice Address - Phone:831-649-3377
Practice Address - Fax:831-649-6725
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2010-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG085126208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CABT058ZMedicare PIN