Healthcare Provider Details

I. General information

NPI: 1881397545
Provider Name (Legal Business Name): CECILIA GOYETTE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/22/2023
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 E SANTA BARBARA ST STE A
SANTA PAULA CA
93060-2675
US

IV. Provider business mailing address

3400 DATA DR ATTENTION: CREDENTIALING AND PAYOR ENROLLMENT DEPT.
RANCHO CORDOVA CA
95670
US

V. Phone/Fax

Practice location:
  • Phone: 805-525-2121
  • Fax: 805-525-3652
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA23943
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: