Provider Demographics
NPI:1144801697
Name:GOLDBERG, SANDRA C (ND, LAC)
Entity Type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:C
Last Name:GOLDBERG
Suffix:
Gender:F
Credentials:ND, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1051 NE 6TH ST # 422
Mailing Address - Street 2:
Mailing Address - City:GRANTS PASS
Mailing Address - State:OR
Mailing Address - Zip Code:97526-1190
Mailing Address - Country:US
Mailing Address - Phone:503-956-1502
Mailing Address - Fax:
Practice Address - Street 1:12900 WOOLMAN LN
Practice Address - Street 2:
Practice Address - City:NEVADA CITY
Practice Address - State:CA
Practice Address - Zip Code:95959-9700
Practice Address - Country:US
Practice Address - Phone:503-956-1502
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-16
Last Update Date:2021-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA380208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty