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General NPI Number Information
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NPI Number | 1467650358
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Entity Type | Individual
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Provider Name | TINA L GOODSON M.D.
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Gender | Female
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Dates
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Enumeration Date | 07/03/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 2810 W CHARLESTON BLVD SUITE 78
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City | LAS VEGAS
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State | NV
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Zip | 89102-1921
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Country | US
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Telephone | 702-968-5084
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Fax |
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Provider Business Mailing Address
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Address Line | 2000 GRAVEL HILL ST UNIT 203
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City | LAS VEGAS
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State | NV
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Zip | 89117-6970
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Country | US
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Telephone | 702-538-8076
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | LL1778
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License Number State | NV
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