Provider Demographics
NPI:1174861769
Name:GOLDBERG, ZACHARY DAVID
Entity Type:Individual
Prefix:MR
First Name:ZACHARY
Middle Name:DAVID
Last Name:GOLDBERG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11680 EVERGREEN CREEK LN
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89135-1650
Mailing Address - Country:US
Mailing Address - Phone:702-606-0735
Mailing Address - Fax:
Practice Address - Street 1:11680 EVERGREEN CREEK LN
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89135-1650
Practice Address - Country:US
Practice Address - Phone:702-606-0735
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-16
Last Update Date:2013-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner