Healthcare Provider Details

I. General information

NPI: 1285201616
Provider Name (Legal Business Name): KAITLIN NICOLE GOODS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KAITLIN NICOLE WOODS

II. Dates (important events)

Enumeration Date: 06/04/2021
Last Update Date: 02/27/2025
Certification Date: 02/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8635 W 3RD ST STE 675
LOS ANGELES CA
90048-6109
US

IV. Provider business mailing address

4140 W 190TH ST
TORRANCE CA
90504-5513
US

V. Phone/Fax

Practice location:
  • Phone: 310-423-5874
  • Fax: 310-423-0139
Mailing address:
  • Phone: 310-423-5874
  • Fax: 310-423-0139

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XX0801X
TaxonomyOrthopaedic Trauma Physician
License NumberPA9114482
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9114482
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA10002
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA65818
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: