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General NPI Number Information
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NPI Number | 1245337302
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Entity Type | Individual
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Provider Name | JUSTIN MATHIAS GOODING M.D.
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Gender | Male
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Dates
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Enumeration Date | 09/20/2006
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Last Update Date | 11/13/2024
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Provider Practice Location Address
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Address Line | 4002 VISTA WAY
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City | OCEANSIDE
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State | CA
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Zip | 92056-4506
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Country | US
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Telephone | 760-940-4055
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Fax |
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Provider Business Mailing Address
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Address Line | 1955 CITRACADO PKWY STE 100
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City | ESCONDIDO
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State | CA
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Zip | 92029-4111
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Country | US
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Telephone | 760-940-4055
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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 | 2085R0204X
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Taxonomy Name | Vascular & Interventional Radiology Physician
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License Number | G78989
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License Number State | CA
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