Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 35.123261 | OH |
N | 208000000X | Pediatrician | 69877 | MN |
N | 2084N0402X | Child Neurologist | 35.123261 | OH |
Y | 2084N0402X | Child Neurologist | 69877 | MN |
NPI | 1275796732 |
---|---|
Provider Name | Dr. Jessica Helena Randa Goldstein |
First Address | Cleveland, OH 44106-1716 |
Second Address | Cleveland, OH 44106-1716 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/07/2008 |
Last Update Date | 11/08/2021 |