Provider Demographics
NPI:1679790661
Name:GOLDSTEIN, ESTELLE TOBY (MD)
Entity Type:Individual
Prefix:DR
First Name:ESTELLE
Middle Name:TOBY
Last Name:GOLDSTEIN
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 1:10843 MAGNOLIA BLVD STE 1A
Mailing Address - Street 2:
Mailing Address - City:NORTH HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91601-3922
Mailing Address - Country:US
Mailing Address - Phone:619-296-6563
Mailing Address - Fax:601-207-9227
Practice Address - Street 1:4411 E KINGS CANYON RD
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93702-3604
Practice Address - Country:US
Practice Address - Phone:559-600-7180
Practice Address - Fax:559-600-7708
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-19
Last Update Date:2021-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC050226174400000X
CAC502262084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE50024Medicare UPIN