Provider Demographics
NPI:1922041060
Name:GOLDSTEIN, MITCHELL REID (MD)
Entity Type:Individual
Prefix:DR
First Name:MITCHELL
Middle Name:REID
Last Name:GOLDSTEIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19115 HARNETT ST
Mailing Address - Street 2:
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91326-3009
Mailing Address - Country:US
Mailing Address - Phone:818-730-9309
Mailing Address - Fax:626-813-3720
Practice Address - Street 1:19115 HARNETT ST
Practice Address - Street 2:
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91326-3009
Practice Address - Country:US
Practice Address - Phone:818-730-9309
Practice Address - Fax:626-813-3720
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG0657022080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine