Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | DC29526 | CA |
NPI | 1417924259 |
---|---|
Provider Name | Dr. Anita Goldstein |
First Address | Culver City, CA 90232-7414 |
Second Address | Culver City, CA 90232-7414 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/03/2006 |
Last Update Date | 11/09/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
V04008 | (02) |