MEDICARE: MS. REBECCA LYNN GOFFINET LVN

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	164X00000X	Licensed Vocational Nurse	VN237510	CA

General Provider Information

NPI Number	:	1528211398
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. REBECCA LYNN GOFFINET LVN

Provider Business Mailing Address
First Line	:	320 VIA DON BENITO
Second Line	:
City	:	CATHEDRAL CITY
State	:	CA
Zip	:	92234-1632
Country	:	US
Telephone Number	:	760-610-9247
Fax Number	:	760-321-0344

Provider Business Practice Location Address
First Line	:	320 VIA DON BENITO
Second Line	:
City	:	CATHEDRAL CITY
State	:	CA
Zip	:	92234-1632
Country	:	US
Telephone Number	:	760-610-9247
Fax Number	:	760-321-0344

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

Provider Enumeration Date	:	10/24/2008
Last Update Date	:	10/24/2008

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