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NPI Code Detail

MEDICARE: NADINE MARIE GODDARD

MEDICARE: NADINE MARIE GODDARD
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) CounselorCA

General Provider Information

NPI Number : 1295212504
Entity Type Code : Individual
Provider Name (Legal Business Name) : NADINE MARIE GODDARD
Provider Business Mailing Address
First Line : 5343 BARSTOW ST
Second Line :
City : SAN DIEGO
State : CA
Zip : 92117-2204
Country : US
Telephone Number : 619-209-1915
Fax Number :
Provider Business Practice Location Address
First Line : 4141 PACIFIC HWY
Second Line :
City : SAN DIEGO
State : CA
Zip : 92110-2030
Country : US
Telephone Number : 209-861-9393
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/20/2018
Last Update Date : 07/20/2018

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Directions to “ NADINE MARIE GODDARD ” Practice Location

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