Provider Demographics
NPI:1083779771
Name:GOLDMAN, CARYN B (LAC, RN)
Entity Type:Individual
Prefix:MS
First Name:CARYN
Middle Name:B
Last Name:GOLDMAN
Suffix:
Gender:F
Credentials:LAC, RN
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:4162 PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94602-1207
Mailing Address - Country:US
Mailing Address - Phone:510-727-1238
Mailing Address - Fax:925-803-5001
Practice Address - Street 1:2881 CASTRO VALLEY BLVD
Practice Address - Street 2:STE Q
Practice Address - City:CASTRO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94546-5566
Practice Address - Country:US
Practice Address - Phone:510-727-1238
Practice Address - Fax:925-803-5001
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 4530171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist