Healthcare Provider Details

I. General information

NPI: 1609399757
Provider Name (Legal Business Name): MARIA TERESA GOODWIN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

113 E F ST
TEHACHAPI CA
93561-1710
US

IV. Provider business mailing address

113 E F ST
TEHACHAPI CA
93561-1710
US

V. Phone/Fax

Practice location:
  • Phone: 661-822-4639
  • Fax:
Mailing address:
  • Phone: 661-822-4639
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: