Provider Demographics
NPI:1700983707
Name:GOEL, SANJIV (MD, FACC)
Entity Type:Individual
Prefix:
First Name:SANJIV
Middle Name:
Last Name:GOEL
Suffix:
Gender:M
Credentials:MD, FACC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 LYNN RD STE 205
Mailing Address - Street 2:
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91360-8040
Mailing Address - Country:US
Mailing Address - Phone:805-497-3585
Mailing Address - Fax:805-497-1313
Practice Address - Street 1:2100 LYNN RD STE 205
Practice Address - Street 2:
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91360-8040
Practice Address - Country:US
Practice Address - Phone:805-497-3585
Practice Address - Fax:805-497-1313
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2014-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA44063207RC0000X, 207RI0011X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A440630OtherMEDICAL
CA77-0333869OtherTIN
CA00A440630OtherMEDICAL
CAW16415Medicare ID - Type Unspecified