MEDICARE: CAROLYN DAWN GOODMAN NP-C

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	363L00000X	Nurse Practitioner	LG-0013783	DE
2	363LF0000X	Family Nurse Practitioner	NPF95008234	CA

General Provider Information

NPI Number	:	1235647728
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAROLYN DAWN GOODMAN NP-C

Provider Business Mailing Address
First Line	:	4140 W 190TH ST
Second Line	:
City	:	TORRANCE
State	:	CA
Zip	:	90504-5513
Country	:	US
Telephone Number	:	310-582-7900
Fax Number	:	310-582-7996

Provider Business Practice Location Address
First Line	:	11800 WILSHIRE BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90025-6602
Country	:	US
Telephone Number	:	310-582-7900
Fax Number	:	310-582-7996

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

Provider Enumeration Date	:	01/18/2018
Last Update Date	:	04/20/2026

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