Provider Demographics
NPI:1245264282
Name:GOLDBERG, MICHELLE (RD)
Entity type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:
Last Name:GOLDBERG
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:551 GIBSON AVE APT 218
Mailing Address - Street 2:
Mailing Address - City:PACIFIC GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:93950-4330
Mailing Address - Country:US
Mailing Address - Phone:661-747-9056
Mailing Address - Fax:
Practice Address - Street 1:473 CABRILLO ST
Practice Address - Street 2:BLDG 422 SUITE A1A
Practice Address - City:PRESIDIO OF MONTEREY
Practice Address - State:CA
Practice Address - Zip Code:93944-3201
Practice Address - Country:US
Practice Address - Phone:831-242-5907
Practice Address - Fax:831-242-6620
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2024-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND 4363133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered