| Provider / Organization | NPI | Date Certified |
|---|---|---|
| KAELEN MARIE GOLDSTEIN | 1548818123 | 2021-01-10 |
| Entity Type | Individual |
| Provider Name | Ms. Kaelen Marie Goldstein |
| Practice Office Address | 1850 E 17TH ST STE 119 SANTA ANA, CA US |
| Practice Office Telephone | 7148839156 |
| Mailing Address | 1 LEAGUE UNIT 63821 IRVINE, CA 926027192 US |
| Business Telephone | 9494330652 |
| Code | License No | State |
|---|---|---|
| 106H00000X PRIMARY |