Provider Demographics
NPI:1740416833
Name:GOLDFARB, GEORGIA A (MD)
Entity Type:Individual
Prefix:DR
First Name:GEORGIA
Middle Name:A
Last Name:GOLDFARB
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 1:20650 WHITECAP WAY
Mailing Address - Street 2:
Mailing Address - City:MALIBU
Mailing Address - State:CA
Mailing Address - Zip Code:90265-5359
Mailing Address - Country:US
Mailing Address - Phone:310-317-4768
Mailing Address - Fax:818-614-3087
Practice Address - Street 1:18555 VENTURA BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-4191
Practice Address - Country:US
Practice Address - Phone:310-628-1700
Practice Address - Fax:818-614-3087
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-03
Last Update Date:2016-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA43687208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics