Healthcare Provider Details

I. General information

NPI: 1962480004
Provider Name (Legal Business Name): GEOFF A. GOODRICH RVT
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/09/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1127 SIERRA LAUREL CT
HENDERSON NV
89014-8701
US

IV. Provider business mailing address

205 N STEPHANIE ST SUITE D #145
HENDERSON NV
89074-8115
US

V. Phone/Fax

Practice location:
  • Phone: 702-339-1560
  • Fax:
Mailing address:
  • Phone: 702-339-1560
  • Fax: 702-436-9892

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246XS1301X
TaxonomySonography Specialist/Technologist Cardiovascular
License Number
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code2471S1302X
TaxonomySonography Radiologic Technologist
License Number
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: