MEDICARE: CASEY A GOODMAN, MD, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician

General Provider Information

NPI Number	:	1104753789
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CASEY A GOODMAN, MD, INC

Provider Business Mailing Address
First Line	:	1814 VIOLA PL APT A
Second Line	:
City	:	COSTA MESA
State	:	CA
Zip	:	92627-8614
Country	:	US
Telephone Number	:	714-261-6540
Fax Number	:

Provider Business Practice Location Address
First Line	:	1814 VIOLA PL APT A
Second Line	:
City	:	COSTA MESA
State	:	CA
Zip	:	92627-8614
Country	:	US
Telephone Number	:	714-261-6540
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	CASEY GOODMAN
Credential	:	MD
Telephone Number	:	714-261-6540

Provider Enumeration Date	:	05/06/2026
Last Update Date	:	05/06/2026

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