Healthcare Provider Details

I. General information

NPI: 1679891790
Provider Name (Legal Business Name): ANNETTE ROSA GOLDMAN PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ANNETTE ROSA GOLDMAN MOSQUEDA PSYD

II. Dates (important events)

Enumeration Date: 05/13/2010
Last Update Date: 03/22/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

731A 2ND AVE
SAN FRANCISCO CA
94118-4020
US

IV. Provider business mailing address

731A 2ND AVE
SAN FRANCISCO CA
94118-4020
US

V. Phone/Fax

Practice location:
  • Phone: 415-517-9235
  • Fax:
Mailing address:
  • Phone: 415-517-9235
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY23504
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: