Healthcare Provider Details

I. General information

NPI: 1720997646
Provider Name (Legal Business Name): MEGAN VICTORIA A GOODACRE MS, RDN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/04/2026
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2192 W PARK DR
MADERA CA
93637-1904
US

IV. Provider business mailing address

2192 W PARK DR
MADERA CA
93637-1904
US

V. Phone/Fax

Practice location:
  • Phone: 559-377-8114
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: