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General NPI Number Information
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NPI Number | 1699094706
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Entity Type | Organization
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Legal Business Name | GLENDA GOODWIN MD INC
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Dates
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Enumeration Date | 05/28/2010
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Last Update Date | 05/28/2010
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Provider Practice Location Address
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Address Line | 7811 LAGUNA BLVD SUITE 216
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City | ELK GROVE
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State | CA
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Zip | 95758-7941
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Country | US
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Telephone | 916-691-4300
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Fax |
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Provider Business Mailing Address
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Address Line | 8156 POLO CROSSE AVE
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City | SACRAMENTO
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State | CA
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Zip | 95829-6545
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. GLENDA DARLENE GOODWIN
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Credential | M.D.
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Telephone | 916-284-8848
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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 | A71660
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License Number State | CA
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