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General NPI Number Information
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NPI Number | 1457733966
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Entity Type | Individual
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Provider Name | MARK TAKESHI GOYA PA-C
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Gender | Male
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Dates
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Enumeration Date | 06/19/2015
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Last Update Date | 12/03/2021
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Provider Practice Location Address
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Address Line | 4502 E AVENUE S
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City | PALMDALE
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State | CA
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Zip | 93552-4480
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Country | US
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Telephone | 833-574-2273
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Fax |
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Provider Business Mailing Address
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Address Line | 5500 KLUMP AVE APT 506
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City | NORTH HOLLYWOOD
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State | CA
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Zip | 91601-2537
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Country | US
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Telephone | 661-703-7918
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 52595
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | 52595
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License Number State | CA
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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 | 52595
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License Number State | CA
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