Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | A169755 | CA |
N | 207Q00000X | Family Doctor | MD60969215 | WA |
NPI | 1003222050 |
---|---|
Provider Name | Alissa Goodwin |
First Address | Portland, OR 97239-3011 |
Second Address | Redding, CA 96001-2461 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/07/2014 |
Last Update Date | 04/09/2020 |