Active NPI
Glenn Paul Goltz, MD
- Ophthalmology Physician
- San Diego, CA
National Provider Identifier
1871009001
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Ophthalmology Physician
- License
- C35609
- Practice address
- 4240 Arguello St
San Diego, CA 92103-1506 - Phone
- (619) 299-0440
- NPI assigned
- Dec 26, 2017
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Ophthalmology Physician | 207W00000X | C35609 | CA | Primary |
Addresses
Primary practice location
4240 Arguello St
San Diego, CA 92103-1506
Mailing address
4240 Arguello St
San Diego, CA 92103-1506
Phone (619) 299-0440
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| C35609 | Other | CA | MEDICAL BOARD OF CALIFORNIA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| C35609 | CA | MD | Ophthalmology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1514246400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1514246400000",
"number": "1871009001",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4240 ARGUELLO ST",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921031506",
"telephone_number": "619-299-0440"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4240 ARGUELLO ST",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921031506",
"telephone_number": "619-299-0440"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GOLTZ",
"first_name": "GLENN",
"middle_name": "PAUL",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2017-12-26",
"last_updated": "2017-12-26",
"status": "A"
},
"taxonomies": [
{
"code": "207W00000X",
"taxonomy_group": "",
"desc": "Ophthalmology",
"state": "CA",
"license": "C35609",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICAL BOARD OF CALIFORNIA",
"identifier": "C35609",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in San Diego, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 26, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.