Basic Information
Provider Information | |||||||||
NPI: | 1750466090 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | MEEZAN | ||||||||
FirstName: | ROBIN | ||||||||
MiddleName: | GOLDENBERG | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | GOLDENBERG | ||||||||
OtherFirstName: | ROBIN | ||||||||
OtherMiddleName: | HEATHER | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | DEPT 34929 | ||||||||
Address2: | P.O. BOX 39000 | ||||||||
City: | SAN FRANCISCO | ||||||||
State: | CA | ||||||||
PostalCode: | 941390001 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9259522828 | ||||||||
FaxNumber: | 9259522850 | ||||||||
Practice Location | |||||||||
Address1: | 3 ALTARINDA RD STE 300 | ||||||||
Address2: |   | ||||||||
City: | ORINDA | ||||||||
State: | CA | ||||||||
PostalCode: | 945632601 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9252549500 | ||||||||
FaxNumber: | 9252549505 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 10/26/2006 | ||||||||
LastUpdateDate: | 07/21/2022 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | A8866Z | CA | Y |   | Allopathic & Osteopathic Physicians | Pediatrics |   |
No ID Information.