Provider Demographics
NPI:1194214882
Name:CARMEL VALLEY NEUROLOGY PC
Entity Type:Organization
Organization Name:CARMEL VALLEY NEUROLOGY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:A
Authorized Official - Last Name:GOLDBERG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:866-393-9869
Mailing Address - Street 1:3830 VALLEY CENTRE DR
Mailing Address - Street 2:STE 705 PMB 423
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92130-3343
Mailing Address - Country:US
Mailing Address - Phone:866-393-9869
Mailing Address - Fax:866-393-9868
Practice Address - Street 1:12264 EL CAMINO REAL STE 303
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92130
Practice Address - Country:US
Practice Address - Phone:866-393-9869
Practice Address - Fax:866-393-9868
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-08
Last Update Date:2018-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
No2084S0012XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologySleep MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADY3247OtherRR MEDICARE GROUP PTAN
CACB298480OtherMEDICARE GROUP PTAN