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General NPI Number Information
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NPI Number | 1013729987
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Entity Type | Individual
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Provider Name | CHARLENE MAY GOODMAN MT
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Gender | Female
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Dates
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Enumeration Date | 01/27/2025
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Last Update Date | 01/27/2025
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Provider Practice Location Address
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Address Line | 1054 2ND ST
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City | ENCINITAS
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State | CA
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Zip | 92024-5009
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Country | US
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Telephone | 858-901-7316
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Fax |
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Provider Business Mailing Address
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Address Line | 1394 DANDELION WAY
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City | SAN MARCOS
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State | CA
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Zip | 92078-0801
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Country | US
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Telephone | 808-358-7423
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 54658
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License Number State | CA
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