Healthcare Provider Details

I. General information

NPI: 1699349977
Provider Name (Legal Business Name): MARGARET ELANA GOODFELLOW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2021
Last Update Date: 05/26/2023
Certification Date: 05/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3250 WILSHIRE BLVD STE 500
LOS ANGELES CA
90010-1427
US

IV. Provider business mailing address

825 S HILL ST APT 2006
LOS ANGELES CA
90014-3291
US

V. Phone/Fax

Practice location:
  • Phone: 702-824-4610
  • Fax:
Mailing address:
  • Phone: 702-824-4610
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: