Provider Demographics
NPI:1770131179
Name:GOLDENBERG, ANTONY PATRIK
Entity type:Individual
Prefix:
First Name:ANTONY
Middle Name:PATRIK
Last Name:GOLDENBERG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26326 W PLATA LN
Mailing Address - Street 2:
Mailing Address - City:CALABASAS
Mailing Address - State:CA
Mailing Address - Zip Code:91302-2611
Mailing Address - Country:US
Mailing Address - Phone:818-297-7632
Mailing Address - Fax:
Practice Address - Street 1:26326 W PLATA LN
Practice Address - Street 2:
Practice Address - City:CALABASAS
Practice Address - State:CA
Practice Address - Zip Code:91302-2611
Practice Address - Country:US
Practice Address - Phone:818-297-7632
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-28
Last Update Date:2019-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program