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General NPI Number Information
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NPI Number | 1063309102
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Entity Type | Individual
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Provider Name | JAN GOLDBERG
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Gender | Female
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Dates
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Enumeration Date | 06/20/2025
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Last Update Date | 06/20/2025
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Provider Practice Location Address
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Address Line | 286 MAY ST
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City | BISHOP
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State | CA
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Zip | 93514-2712
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Country | US
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Telephone | 530-400-7541
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Fax |
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Provider Business Mailing Address
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Address Line | 128 HUERTA PL
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City | DAVIS
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State | CA
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Zip | 95616-0269
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Country | US
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Telephone | 530-400-7541
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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 | 133NN1002X
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Taxonomy Name | Nutrition Education Nutritionist
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License Number |
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License Number State |
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