Healthcare Provider Details

I. General information

NPI: 1265840755
Provider Name (Legal Business Name): AMANDA GOODING PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2014
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5230 CARROLL CANYON RD STE 100
SAN DIEGO CA
92121-1779
US

IV. Provider business mailing address

4653 CARMEL MOUNTAIN RD STE 308 PMB 1030
SAN DIEGO CA
92130-6650
US

V. Phone/Fax

Practice location:
  • Phone: 858-380-5856
  • Fax: 858-500-5036
Mailing address:
  • Phone: 858-380-5856
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number28757
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: