Healthcare Provider Details

I. General information

NPI: 1427630623
Provider Name (Legal Business Name): JUSTINE J GOODYEAR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/27/2021
Last Update Date: 01/13/2025
Certification Date: 01/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44225 SUMMER SWEET WAY
CALIFORNIA MD
20619-4031
US

IV. Provider business mailing address

45021 CLARK DR
CALIFORNIA MD
20619-2434
US

V. Phone/Fax

Practice location:
  • Phone: 757-387-9087
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: