Healthcare Provider Details

I. General information

NPI: 1831159714
Provider Name (Legal Business Name): JEFFREY SCOTT GOODMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/24/2006
Last Update Date: 07/11/2025
Certification Date: 07/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8635 W 3RD ST STE 480W
LOS ANGELES CA
90048-6101
US

IV. Provider business mailing address

8635 W 3RD ST STE 480W
LOS ANGELES CA
90048-6101
US

V. Phone/Fax

Practice location:
  • Phone: 310-659-4081
  • Fax:
Mailing address:
  • Phone: 310-659-4081
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License NumberG067030
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License NumberG67030
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: