Provider Demographics
NPI:1770623761
Name:GOLDBERG, HERBERT MICHAEL (MD)
Entity type:Individual
Prefix:DR
First Name:HERBERT
Middle Name:MICHAEL
Last Name:GOLDBERG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:HERBERT
Other - Middle Name:MICHAEL
Other - Last Name:GOLDBERG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:4403 OCEAN FRONT WALK APT 204
Mailing Address - Street 2:
Mailing Address - City:MARINA DEL REY
Mailing Address - State:CA
Mailing Address - Zip Code:90292-6733
Mailing Address - Country:US
Mailing Address - Phone:310-821-1904
Mailing Address - Fax:310-821-1916
Practice Address - Street 1:4403 OCEAN FRONT WALK APT 204
Practice Address - Street 2:
Practice Address - City:MARINA DEL REY
Practice Address - State:CA
Practice Address - Zip Code:90292-6733
Practice Address - Country:US
Practice Address - Phone:310-821-1904
Practice Address - Fax:310-821-1916
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC32251208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery