Provider Demographics
NPI:1154655983
Name:GOLDENBERG, LAUREN PEARLMAN (DO)
Entity Type:Individual
Prefix:DR
First Name:LAUREN
Middle Name:PEARLMAN
Last Name:GOLDENBERG
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:LAUREN
Other - Middle Name:NICOLE
Other - Last Name:PEARLMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:2601 E ROOSEVELT ST
Mailing Address - Street 2:PEDIATRICS DEPARTMENT
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85008-4973
Mailing Address - Country:US
Mailing Address - Phone:602-344-5404
Mailing Address - Fax:602-344-5859
Practice Address - Street 1:2601 E ROOSEVELT ST
Practice Address - Street 2:PEDIATRICS DEPARTMENT
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85008-4973
Practice Address - Country:US
Practice Address - Phone:602-344-5404
Practice Address - Fax:602-344-5859
Is Sole Proprietor?:No
Enumeration Date:2009-09-26
Last Update Date:2021-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A 11516208000000X
AZR1491208000000X
AZ005673208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ612419Medicaid