Healthcare Provider Details

I. General information

NPI: 1811791056
Provider Name (Legal Business Name): LAUREN GOODMAN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LAUREN PHELPS

II. Dates (important events)

Enumeration Date: 04/04/2025
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9730 WILSHIRE BLVD STE 111
BEVERLY HILLS CA
90212-2003
US

IV. Provider business mailing address

1280 MEADOWBROOK AVE
LOS ANGELES CA
90019-2815
US

V. Phone/Fax

Practice location:
  • Phone: 805-720-0133
  • Fax:
Mailing address:
  • Phone: 805-720-0133
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number95148672
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number95040421
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: