Healthcare Provider Details

I. General information

NPI: 1104753789
Provider Name (Legal Business Name): CASEY A GOODMAN, MD, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/06/2026
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1814 VIOLA PL APT A
COSTA MESA CA
92627-8614
US

IV. Provider business mailing address

1814 VIOLA PL APT A
COSTA MESA CA
92627-8614
US

V. Phone/Fax

Practice location:
  • Phone: 714-261-6540
  • Fax:
Mailing address:
  • Phone: 714-261-6540
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: CASEY GOODMAN
Title or Position: PRESIDENT
Credential: MD
Phone: 714-261-6540