Provider Demographics
NPI:1235125337
Name:GOLDBERG, RONALD K (MD)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:K
Last Name:GOLDBERG
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:5565 GROSSMONT CENTER DR
Mailing Address - Street 2:BLDG.3, SUITE 455
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91942-3020
Mailing Address - Country:US
Mailing Address - Phone:619-462-9353
Mailing Address - Fax:619-462-6038
Practice Address - Street 1:5565 GROSSMONT CENTER DR
Practice Address - Street 2:BLDG.3, SUITE 455
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942-3020
Practice Address - Country:US
Practice Address - Phone:619-462-9353
Practice Address - Fax:619-462-6038
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-23
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG65437207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE07573Medicare UPIN
CAWG65437BMedicare ID - Type UnspecifiedMEDICARE