Healthcare Provider Details

I. General information

NPI: 1285757294
Provider Name (Legal Business Name): LINDA LEA GOFF MRT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/06/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1178 CORTE RIVIERA
CAMARILLO CA
93010-7431
US

IV. Provider business mailing address

1178 CORTE RIVIERA
CAMARILLO CA
93010-7431
US

V. Phone/Fax

Practice location:
  • Phone: 805-577-0830
  • Fax: 805-581-2852
Mailing address:
  • Phone: 805-577-0830
  • Fax: 805-581-2852

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMQ17831
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: