Healthcare Provider Details

I. General information

NPI: 1124217708
Provider Name (Legal Business Name): CHRISTY M GOFF
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/18/2007
Last Update Date: 01/16/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16490 BEACH BLVD
WESTMINSTER CA
92683-7866
US

IV. Provider business mailing address

FILE # 55745
LOS ANGELES CA
90074-5745
US

V. Phone/Fax

Practice location:
  • Phone: 714-843-9797
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number2544
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: