Provider Demographics
NPI:1376100719
Name:GOLDBERG, BRIAN O'BRIEN
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:O'BRIEN
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 1:733 N 150TH ST
Mailing Address - Street 2:
Mailing Address - City:SHORELINE
Mailing Address - State:WA
Mailing Address - Zip Code:98133-6104
Mailing Address - Country:US
Mailing Address - Phone:206-816-0239
Mailing Address - Fax:
Practice Address - Street 1:733 N 150TH ST
Practice Address - Street 2:
Practice Address - City:SHORELINE
Practice Address - State:WA
Practice Address - Zip Code:98133-6104
Practice Address - Country:US
Practice Address - Phone:206-816-0239
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-21
Last Update Date:2019-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program