Healthcare Provider Details

I. General information

NPI: 1649134891
Provider Name (Legal Business Name): SPENCER GOSS RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/12/2025
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

259 N 9TH ST
GROVER BEACH CA
93433-2123
US

IV. Provider business mailing address

259 N 9TH ST
GROVER BEACH CA
93433-2123
US

V. Phone/Fax

Practice location:
  • Phone: 805-215-2739
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95256084
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: