NICOLE GOLDBERG-BOLTZ MD
NPI 1093455784
Student in an Organized Health Care Education/Training Program in Santa Rosa, CA

Q: What is Nicole Goldberg-boltz's NPI number?

The NPI number for Nicole Goldberg-boltz is 1093455784. It was assigned to this individual provider in the NPPES registry on March 30, 2022.

Q: What is Nicole Goldberg-boltz's specialty?

The primary specialty registered for this NPI is Student in an Organized Health Care Education/Training Program with taxonomy code 390200000X.

Active since March 30, 2022PECOS Enrolled

3569 ROUND BARN CIR STE 200, SANTA ROSA, CA 95403(707) 583-8800 Get Directions Write a Review

NPPES record last updated: March 30, 2022. Verified against the NPPES registry weekly; last sync: August 02, 2026.

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About Nicole Goldberg-boltz Md NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

NICOLE GOLDBERG-BOLTZ MD (NPI 1093455784) is an individual student in an organized health care education/training program in Santa Rosa, California and active in the NPI registry since March 2022. She is enrolled in Medicare PECOS and is a graduate of University Of Arizona College Of Medicine (2022).

NPPES Registry Identity

NPI1093455784

Entity TypeIndividualFemale

Primary Taxonomy390200000X

Provider Legal NameNICOLE GOLDBERG-BOLTZCredential: MD

Location Address3569 ROUND BARN CIR STE 200Santa Rosa, CA 95403-5784

Mailing Address3569 Round Barn Cir Ste 200Santa Rosa, CA 95403-5784 · (707) 583-8800

Phone(707) 583-8800

Sole ProprietorNo

Medical School CMSUniversity Of Arizona College Of MedicineGraduated 2022

Enumeration DateMarch 30, 2022

NPPES CertifiedMarch 30, 2022

✔ NPI 1093455784 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyStudent in an Organized Health Care Education/Training ProgramStudent, Health Care

Taxonomy Code390200000X

Definition

An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.

3569 ROUND BARN CIR STE 200, Santa Rosa, CA 95403

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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Nicole Goldberg-boltz Md is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

PECOS PAC ID4981180502

PECOS Enrollment IDI20260113002122

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

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Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. KENDALL MADDEN M.D.

Student in an Organized Health Care Education/Training Program