Provider Demographics
NPI:1891390274
Name:GOLDMAN, LINDSAY MARA (PA)
Entity Type:Individual
Prefix:
First Name:LINDSAY
Middle Name:MARA
Last Name:GOLDMAN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5621 MIDDLE CREST DR
Mailing Address - Street 2:
Mailing Address - City:AGOURA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91301-4069
Mailing Address - Country:US
Mailing Address - Phone:818-326-4222
Mailing Address - Fax:
Practice Address - Street 1:2110 W SUNSET BLVD STE M
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90026-7318
Practice Address - Country:US
Practice Address - Phone:833-873-2852
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-02
Last Update Date:2021-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant