Provider Demographics
NPI:1083328421
Name:GOLDBERG, CASSANDRA JOAN (DC)
Entity Type:Individual
Prefix:DR
First Name:CASSANDRA
Middle Name:JOAN
Last Name:GOLDBERG
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 BRIDGETOWN BND
Mailing Address - Street 2:
Mailing Address - City:CORONADO
Mailing Address - State:CA
Mailing Address - Zip Code:92118-3258
Mailing Address - Country:US
Mailing Address - Phone:619-820-8477
Mailing Address - Fax:
Practice Address - Street 1:1109 8TH ST
Practice Address - Street 2:
Practice Address - City:CORONADO
Practice Address - State:CA
Practice Address - Zip Code:92118-2217
Practice Address - Country:US
Practice Address - Phone:619-537-6833
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-10
Last Update Date:2023-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA36435111NP0017X, 111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NP0017XChiropractic ProvidersChiropractorPediatric Chiropractor