Provider Demographics
NPI:1558594994
Name:GOLDMAN, RICHARD LYLE (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:LYLE
Last Name:GOLDMAN
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 1:18892 PATRICIAN DR.
Mailing Address - Street 2:
Mailing Address - City:VILLA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:92861
Mailing Address - Country:US
Mailing Address - Phone:714-532-1202
Mailing Address - Fax:714-532-1430
Practice Address - Street 1:18892 PATRICIAN DR.
Practice Address - Street 2:
Practice Address - City:VILLA PARK
Practice Address - State:CA
Practice Address - Zip Code:92861
Practice Address - Country:US
Practice Address - Phone:714-532-1202
Practice Address - Fax:714-532-1430
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-02
Last Update Date:2009-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAFE 16964207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology