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1033555024 NPI number — CHRISTINA MARIE GOODWIN M.D.

NPI Number: 1033555024
Health Care Provider/Practitioner: CHRISTINA MARIE GOODWIN M.D.

Information about “1033555024” NPI (CHRISTINA MARIE GOODWIN M.D.) exists in 1033555024 in HTML format HTML  |  1033555024 in plain Text format TXT  |  1033555024 in PDF (Portable Document Format) PDF  |  1033555024 in an XML format XML  formats.

NPI Number : 1033555024 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1033555024",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "GOODWIN",
    "FirstName": "CHRISTINA",
    "MiddleName": "MARIE",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "M.D.",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "KOPRIVA",
    "OtherFirstName": "CHRISTINA",
    "OtherMiddleName": "MARIE",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "1165 MONTGOMERY DR",
    "SecondLineMailingAddress": "M/S 1W04",
    "MailingAddressCityName": "SANTA ROSA",
    "MailingAddressStateName": "CA",
    "MailingAddressPostalCode": "95405-4801",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "707-547-5471",
    "MailingAddressFaxNumber": "707-525-5280",
    "FirstLinePracticeLocationAddress": "1165 MONTGOMERY DR",
    "SecondLinePracticeLocationAddress": "M/S 1W04",
    "PracticeLocationAddressCityName": "SANTA ROSA",
    "PracticeLocationAddressStateName": "CA",
    "PracticeLocationAddressPostalCode": "95405-4801",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "707-547-5471",
    "PracticeLocationAddressFaxNumber": "707-525-5280",
    "EnumerationDate": "05/16/2013",
    "LastUpdateDate": "07/09/2020",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "207P00000X",
        "TaxonomyName": "Emergency Medicine Physician",
        "LicenseNumber": "140665",
        "LicenseNumberStateCode": "CA",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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