Provider Demographics
NPI:1962463836
Name:GOLDENBERG, DANIELA CELIA (MD)
Entity Type:Individual
Prefix:DR
First Name:DANIELA
Middle Name:CELIA
Last Name:GOLDENBERG
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 1:1130 NW 22ND AVE
Mailing Address - Street 2:220
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97210-2900
Mailing Address - Country:US
Mailing Address - Phone:503-413-8988
Mailing Address - Fax:503-274-4815
Practice Address - Street 1:1130 NW 22ND AVE
Practice Address - Street 2:220
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97210-2900
Practice Address - Country:US
Practice Address - Phone:503-413-8988
Practice Address - Fax:503-274-4815
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD24509207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR227439Medicaid
OR116830Medicare ID - Type Unspecified
H93817Medicare UPIN