MEDICARE: DR. ELIZABETH LENA GOODING

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	103TC0700X	Clinical Psychologist	PSY26978	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1932356128	OTHER	CA	SELF

General Provider Information

NPI Number	:	1932356128
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ELIZABETH LENA GOODING

Provider Business Mailing Address
First Line	:	1101 S WINCHESTER BLVD STE A101
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95128-3914
Country	:	US
Telephone Number	:	408-874-6470
Fax Number	:

Provider Business Practice Location Address
First Line	:	1101 S WINCHESTER BLVD STE A101
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95128-3914
Country	:	US
Telephone Number	:	408-874-6470
Fax Number	:

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

Provider Enumeration Date	:	08/19/2008
Last Update Date	:	03/19/2016

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