Basic Information
| Provider Information | |||||||||
| NPI: | 1891390274 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GOLDMAN | ||||||||
| FirstName: | LINDSAY | ||||||||
| MiddleName: | MARA | ||||||||
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| Credential: | PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5621 MIDDLE CREST DR | ||||||||
| Address2: | |||||||||
| City: | AGOURA HILLS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913014069 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8183264222 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2110 W SUNSET BLVD STE M | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900267318 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8338732852 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/02/2020 | ||||||||
| LastUpdateDate: | 05/03/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/03/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.