Healthcare Provider Details

I. General information

NPI: 1629200118
Provider Name (Legal Business Name): BERTHA COZZETTEA GOINS RN, MS, IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/17/2009
Last Update Date: 11/23/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

531 LOS ANGELES PL
SAN DIEGO CA
92114-5323
US

IV. Provider business mailing address

PO BOX 211236
CHULA VISTA CA
91921-1236
US

V. Phone/Fax

Practice location:
  • Phone: 619-318-7490
  • Fax:
Mailing address:
  • Phone: 619-318-7490
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number10521784IBCLC
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number548713
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number548713
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number548713
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: