Healthcare Provider Details

I. General information

NPI: 1811867013
Provider Name (Legal Business Name): SVETLANA Y GOUTNIK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/11/2025
Last Update Date: 11/11/2025
Certification Date: 11/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 DUARTE RD
DUARTE CA
91010-3012
US

IV. Provider business mailing address

1500 DUARTE RD
DUARTE CA
91010-3012
US

V. Phone/Fax

Practice location:
  • Phone: 626-301-8305
  • Fax: 626-301-8437
Mailing address:
  • Phone: 626-301-8305
  • Fax: 626-301-8437

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835X0200X
TaxonomyOncology Pharmacist
License Number58830
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: