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General NPI Number Information
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NPI Number | 1144412214
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Entity Type | Individual
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Provider Name | LORAINE GOODWIN M.D.
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Gender | Female
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Dates
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Enumeration Date | 08/13/2007
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Last Update Date | 08/13/2007
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Provider Practice Location Address
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Address Line | 1001 W 4TH ST
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City | MADERA
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State | CA
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Zip | 93637-4423
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Country | US
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Telephone | 559-674-4343
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Fax |
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Provider Business Mailing Address
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Address Line | 1625 HOWARD RD # 277
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City | MADERA
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State | CA
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Zip | 93637-5128
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Country | US
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Telephone |
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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 | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number | G52751
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License Number State | CA
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