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General NPI Number Information
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NPI Number | 1831363449
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Entity Type | Individual
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Provider Name | MR. RICHARD VAN GOETHEM
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Gender | Male
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Dates
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Enumeration Date | 04/15/2008
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Last Update Date | 04/07/2023
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Provider Practice Location Address
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Address Line | 25143 JACK RABBIT ACRES
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City | ESCONDIDO
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State | CA
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Zip | 92026-1267
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Country | US
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Telephone | 760-556-8648
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Fax | 619-398-2168
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Provider Business Mailing Address
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Address Line | 25143 JACK RABBIT ACRES, ESCONDIDO, CA 92025
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City | SAN DIEGO
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State | CA
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Zip | 92025
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Country | US
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Telephone | 760-566-8648
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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 | 163WP0809X
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Taxonomy Name | Adult Psychiatric/Mental Health Registered Nurse
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License Number | 465143
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License Number State | CA
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