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NPI Code Detail

MEDICARE: MOINETTE GOODROAD

MEDICARE: MOINETTE GOODROAD
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
1101YA0400XAddiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number : 1174655302
Entity Type Code : Individual
Provider Name (Legal Business Name) : MOINETTE GOODROAD
Provider Business Mailing Address
First Line : 1049 HOWARD ST
Second Line :
City : SAN FRANCISCO
State : CA
Zip : 94103-2822
Country : US
Telephone Number : 415-487-2140
Fax Number : 415-487-2142
Provider Business Practice Location Address
First Line : 1049 HOWARD ST
Second Line :
City : SAN FRANCISCO
State : CA
Zip : 94103-2822
Country : US
Telephone Number : 415-487-2140
Fax Number : 415-487-2142
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/12/2007
Last Update Date : 05/21/2012

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Directions to “ MOINETTE GOODROAD ” Practice Location

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