Provider Demographics
NPI:1972534238
Name:GOLDSTEIN, LEONARD IRWIN (MD FACP)
Entity Type:Individual
Prefix:
First Name:LEONARD
Middle Name:IRWIN
Last Name:GOLDSTEIN
Suffix:
Gender:M
Credentials:MD FACP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7247
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90406-7247
Mailing Address - Country:US
Mailing Address - Phone:310-442-2113
Mailing Address - Fax:310-442-9596
Practice Address - Street 1:100 UCLA MEDICAL PLZ
Practice Address - Street 2:SUITE 240
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90024-6970
Practice Address - Country:US
Practice Address - Phone:310-208-2355
Practice Address - Fax:310-824-2781
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2010-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG16659207RG0100X, 207RI0008X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0008XAllopathic & Osteopathic PhysiciansInternal MedicineHepatology
No207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G166590Medicaid
CAG16659Medicare ID - Type Unspecified
CA00G166590Medicaid