Provider Demographics
NPI:1255370680
Name:GOLDWASSER, HARRY DAVID (MD)
Entity type:Individual
Prefix:DR
First Name:HARRY
Middle Name:DAVID
Last Name:GOLDWASSER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5510 ROBERTS RD
Mailing Address - Street 2:
Mailing Address - City:YUCCA VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92284-2168
Mailing Address - Country:US
Mailing Address - Phone:520-237-0757
Mailing Address - Fax:
Practice Address - Street 1:41870 GARSTIN DR
Practice Address - Street 2:
Practice Address - City:BIG BEAR LAKE
Practice Address - State:CA
Practice Address - Zip Code:92315-2088
Practice Address - Country:US
Practice Address - Phone:909-878-8246
Practice Address - Fax:909-746-4304
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-04
Last Update Date:2025-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG1326422084P0800X
CA1326422084P0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0802XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZE72813Medicare UPIN