Healthcare Provider Details

I. General information

NPI: 1548827264
Provider Name (Legal Business Name): MR. DANIEL MITCHELL GOODMAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2019
Last Update Date: 02/05/2026
Certification Date: 02/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2625 TOWNSGATE RD STE 102
THOUSAND OAKS CA
91361-5726
US

IV. Provider business mailing address

23860 ERIN PL
WEST HILLS CA
91304-6144
US

V. Phone/Fax

Practice location:
  • Phone: 805-413-3009
  • Fax:
Mailing address:
  • Phone: 818-456-3653
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: