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General NPI Number Information
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NPI Number | 1396362091
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Entity Type | Individual
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Provider Name | JENNIFER GOEDDEL MD
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Gender | Female
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Dates
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Enumeration Date | 06/29/2020
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Last Update Date | 10/01/2024
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Provider Practice Location Address
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Address Line | 1418 E MAIN ST STE 210
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City | SANTA MARIA
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State | CA
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Zip | 93454-4836
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Country | US
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Telephone | 805-928-3678
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Fax | 805-928-6408
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Provider Business Mailing Address
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Address Line | 2050 S BLOSSER RD
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City | SANTA MARIA
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State | CA
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Zip | 93458-7310
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Country | US
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Telephone | 805-361-8017
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Fax | 805-361-8097
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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 | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 2020018851
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | A197105
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License Number State | CA
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