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General NPI Number Information
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NPI Number | 1841519675
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Entity Type | Individual
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Provider Name | DAVID GOLDEEN MASSAGE THERAPIST
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Gender | Male
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Dates
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Enumeration Date | 05/18/2010
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Last Update Date | 02/06/2023
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Provider Practice Location Address
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Address Line | 715 DIXIE LN
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City | SAN LUIS OBISPO
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State | CA
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Zip | 93401-8215
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Country | US
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Telephone | 805-801-7128
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Fax |
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Provider Business Mailing Address
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Address Line | 8028 E WHITTON AVE
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City | SCOTTSDALE
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State | AZ
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Zip | 85251-4847
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Country | US
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Telephone | 480-787-1897
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | 0714808
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License Number State | CA
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