Healthcare Provider Details

I. General information

NPI: 1033466198
Provider Name (Legal Business Name): CORIE GOULD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2012
Last Update Date: 07/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 GRAND AVE
PIEDMONT CA
94610-1002
US

IV. Provider business mailing address

5995 19 MILE RD
STERLING HEIGHTS MI
48314-2104
US

V. Phone/Fax

Practice location:
  • Phone: 510-655-7880
  • Fax: 510-655-3379
Mailing address:
  • Phone: 586-254-5454
  • Fax: 586-254-6066

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: