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General NPI Number Information
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NPI Number | 1285201616
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Entity Type | Individual
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Provider Name | KAITLIN NICOLE GOODS PA-C
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Gender | Female
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Dates
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Enumeration Date | 06/04/2021
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Last Update Date | 02/27/2025
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Provider Practice Location Address
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Address Line | 8635 W 3RD ST STE 675
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City | LOS ANGELES
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State | CA
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Zip | 90048-6109
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Country | US
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Telephone | 310-423-5874
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Fax | 310-423-0139
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Provider Business Mailing Address
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Address Line | 4140 W 190TH ST
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City | TORRANCE
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State | CA
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Zip | 90504-5513
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Country | US
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Telephone | 310-423-5874
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Fax | 310-423-0139
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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 | 207XX0801X
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Taxonomy Name | Orthopaedic Trauma Physician
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License Number | PA9114482
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA9114482
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA10002
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License Number State | CA
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Taxonomy #4
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA65818
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License Number State | CA
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