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General NPI Number Information
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NPI Number | 1073876504
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Entity Type | Individual
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Provider Name | DR. JEFFERY ALLEN GOAD
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Gender | Male
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Dates
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Enumeration Date | 06/20/2012
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Last Update Date | 11/21/2022
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Provider Practice Location Address
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Address Line | 402 N GLASSELL ST
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City | ORANGE
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State | CA
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Zip | 92866-1034
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Country | US
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Telephone | 714-744-7077
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Fax |
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Provider Business Mailing Address
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Address Line | 9401 JERONIMO RD
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City | IRVINE
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State | CA
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Zip | 92618-1908
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Country | US
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Telephone | 714-516-5491
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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 | 1835P0018X
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Taxonomy Name | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
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License Number | 47375
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License Number State | CA
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