Healthcare Provider Details

I. General information

NPI: 1356669865
Provider Name (Legal Business Name): LINDSEY RAE GOETZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2010
Last Update Date: 01/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4150 V STREET PSSB 3500
SACRAMENTO CA
95817-1460
US

IV. Provider business mailing address

4150 V STREET PSSB 3500
SACRAMENTO CA
95817-1460
US

V. Phone/Fax

Practice location:
  • Phone: 916-734-3014
  • Fax: 916-734-7920
Mailing address:
  • Phone: 916-734-3014
  • Fax: 916-734-7920

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number079260
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberMED-PHYS-LIC-60599
License Number StateMT
# 3
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberDR0052324
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: