Healthcare Provider Details

I. General information

NPI: 1003222050
Provider Name (Legal Business Name): ALISSA GOODWIN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2014
Last Update Date: 04/10/2026
Certification Date: 04/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2510 AIRPARK DR STE 201
REDDING CA
96001-2461
US

IV. Provider business mailing address

PO BOX 434
ARLEE MT
59821-0434
US

V. Phone/Fax

Practice location:
  • Phone: 530-244-4034
  • Fax:
Mailing address:
  • Phone: 406-270-4897
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD60969215
License Number StateWA
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA169755
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: