Provider Demographics
NPI:1407389471
Name:GOODSTEIN, EMMA (MD)
Entity Type:Individual
Prefix:DR
First Name:EMMA
Middle Name:
Last Name:GOODSTEIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2145 CAJA DEL ORO GRANT RD
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87507-3279
Mailing Address - Country:US
Mailing Address - Phone:505-982-4425
Mailing Address - Fax:
Practice Address - Street 1:2145 CAJA DEL ORO GRANT RD
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87507-3279
Practice Address - Country:US
Practice Address - Phone:505-982-4425
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-06
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZNOT AVAILABLE207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine