Individual
MARK R GOLDBERG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1239 MCHENRY AVE STE A, MODESTO, CA 95350-5330
(209) 491-5200
(209) 526-0935
Mailing address
PO BOX 1630, WATSONVILLE, CA 95077-1630
(209) 491-4960
(209) 566-0705
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
G69198
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
G69198
CALIFORNIA MEDICAL LICENSE
CA
Enumeration date
07/10/2006
Last updated
03/22/2023
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