MEDICARE: CHRISTY M GOFF

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	231H00000X	Audiologist	2544	CA

General Provider Information

NPI Number	:	1124217708
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTY M GOFF

Provider Business Mailing Address
First Line	:	FILE # 55745
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90074-5745
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	16490 BEACH BLVD
Second Line	:
City	:	WESTMINSTER
State	:	CA
Zip	:	92683-7866
Country	:	US
Telephone Number	:	714-843-9797
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/18/2007
Last Update Date	:	01/16/2009

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