Provider Demographics
NPI:1689106205
Name:GOLDBERG, AARON JOSEPH (MD)
Entity Type:Individual
Prefix:DR
First Name:AARON
Middle Name:JOSEPH
Last Name:GOLDBERG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 S MAIN ST
Mailing Address - Street 2:SUITE 525
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-4509
Mailing Address - Country:US
Mailing Address - Phone:714-456-5631
Mailing Address - Fax:714-285-0389
Practice Address - Street 1:505 S MAIN ST
Practice Address - Street 2:SUITE 525
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-4509
Practice Address - Country:US
Practice Address - Phone:714-456-5631
Practice Address - Fax:714-285-0389
Is Sole Proprietor?:No
Enumeration Date:2017-04-02
Last Update Date:2020-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CAA159162208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program