Provider Demographics
NPI:1538290929
Name:GOLDENBERG, VIKTORIYA (OD)
Entity Type:Individual
Prefix:
First Name:VIKTORIYA
Middle Name:
Last Name:GOLDENBERG
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8554 DE SOTO AVE UNIT 44
Mailing Address - Street 2:
Mailing Address - City:CANOGA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91304-2993
Mailing Address - Country:US
Mailing Address - Phone:323-804-4794
Mailing Address - Fax:
Practice Address - Street 1:6433 FALLBROOK AVE
Practice Address - Street 2:
Practice Address - City:WEST HILLS
Practice Address - State:CA
Practice Address - Zip Code:91307-3543
Practice Address - Country:US
Practice Address - Phone:818-703-1410
Practice Address - Fax:818-703-9079
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2007-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12754T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist