Healthcare Provider Details

I. General information

NPI: 1366252256
Provider Name (Legal Business Name): MINDY GOODLETT PHYSICIAN ASSISTANT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/13/2025
Last Update Date: 03/12/2026
Certification Date: 03/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3900 5TH AVE STE 300
SAN DIEGO CA
92103-3138
US

IV. Provider business mailing address

50100 GOLSH RD
VALLEY CENTER CA
92082-5338
US

V. Phone/Fax

Practice location:
  • Phone: 858-554-1212
  • Fax:
Mailing address:
  • Phone: 760-215-3670
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number67305
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: