MEDICARE: FAITH GOAN

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	390200000X	Student in an Organized Health Care Education/Training Program

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	810533740	OTHER	TX	UNITED HEALTHCARE

General Provider Information

NPI Number	:	1669003513
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FAITH GOAN

Provider Business Mailing Address
First Line	:	7614 BRIGHT LAKE BEND LN
Second Line	:
City	:	RICHMOND
State	:	TX
Zip	:	77407-4494
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7614 BRIGHT LAKE BEND LN
Second Line	:
City	:	RICHMOND
State	:	TX
Zip	:	77407-4494
Country	:	US
Telephone Number	:	281-799-6800
Fax Number	:

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

Provider Enumeration Date	:	01/30/2020
Last Update Date	:	01/30/2020

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Directions to “ FAITH GOAN ” Practice Location

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