Provider Demographics
NPI:1790921351
Name:GOLDBERG, RENEE CLAIRE (LVN)
Entity Type:Individual
Prefix:MRS
First Name:RENEE
Middle Name:CLAIRE
Last Name:GOLDBERG
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4440 CALLE REAL
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93110-1002
Mailing Address - Country:US
Mailing Address - Phone:805-683-1491
Mailing Address - Fax:805-683-3631
Practice Address - Street 1:4440 CALLE REAL
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93110-1002
Practice Address - Country:US
Practice Address - Phone:805-683-1491
Practice Address - Fax:805-683-3631
Is Sole Proprietor?:No
Enumeration Date:2008-12-31
Last Update Date:2008-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN 119312164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAVN 119312OtherLVN NURSING LICENSE