Provider Demographics
NPI:1568559557
Name:SANJIV GOEL, M.D., INC.
Entity Type:Organization
Organization Name:SANJIV GOEL, M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT / C.E.O.
Authorized Official - Prefix:
Authorized Official - First Name:SANJIV
Authorized Official - Middle Name:
Authorized Official - Last Name:GOEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD, FACC
Authorized Official - Phone:805-497-3585
Mailing Address - Street 1:2100 LYNN RD STE 205
Mailing Address - Street 2:
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91360-8040
Mailing Address - Country:US
Mailing Address - Phone:805-497-3585
Mailing Address - Fax:805-497-1313
Practice Address - Street 1:2100 LYNN RD STE 205
Practice Address - Street 2:
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91360-8040
Practice Address - Country:US
Practice Address - Phone:805-497-3585
Practice Address - Fax:805-497-1313
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-10
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA44063207R00000X, 207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A440630OtherMEDICAL
CA=========OtherTIN
CAB49433Medicare UPIN