Healthcare Provider Details

I. General information

NPI: 1932813540
Provider Name (Legal Business Name): INGRID GOELST MM, MT-BC, NICU-MT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2023
Last Update Date: 01/09/2023
Certification Date: 01/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

611 N BRAND BLVD STE 100
GLENDALE CA
91203-3240
US

IV. Provider business mailing address

6160 CORNERSTONE CT E STE 100
SAN DIEGO CA
92121-3724
US

V. Phone/Fax

Practice location:
  • Phone: 747-286-2600
  • Fax: 747-204-0181
Mailing address:
  • Phone: 858-216-8837
  • Fax: 888-383-0040

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225A00000X
TaxonomyMusic Therapist
License Number12246
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: