Provider Demographics
NPI:1740446509
Name:GOLDSMITH, MIJA (CFNP)
Entity type:Individual
Prefix:MRS
First Name:MIJA
Middle Name:
Last Name:GOLDSMITH
Suffix:
Gender:F
Credentials:CFNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3706 S PATTON AVE
Mailing Address - Street 2:
Mailing Address - City:SAN PEDRO
Mailing Address - State:CA
Mailing Address - Zip Code:90731-6034
Mailing Address - Country:US
Mailing Address - Phone:310-519-1384
Mailing Address - Fax:
Practice Address - Street 1:1430 SAN JULIAN ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90015-3142
Practice Address - Country:US
Practice Address - Phone:213-765-2800
Practice Address - Fax:213-765-3861
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-31
Last Update Date:2008-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12845363LS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LS0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerSchool