Provider Demographics
NPI:1407800246
Name:GOLDSTEIN, PAUL ROBERT (MD)
Entity Type:Individual
Prefix:MR
First Name:PAUL
Middle Name:ROBERT
Last Name:GOLDSTEIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7930 FROST STREET
Mailing Address - Street 2:#307
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123
Mailing Address - Country:US
Mailing Address - Phone:858-566-5100
Mailing Address - Fax:858-566-1108
Practice Address - Street 1:7930 FROST STREET
Practice Address - Street 2:#307
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123
Practice Address - Country:US
Practice Address - Phone:858-566-5100
Practice Address - Fax:858-566-1108
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG18938207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G189381Medicaid
00G189381Medicare ID - Type Unspecified
A40464Medicare UPIN