Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RI0200X | Infectious Disease | G78029 | CA |
NPI | 1063464360 |
---|---|
Provider Name | Dr. Claudia Goulston |
First Address | Salt Lake City, UT 84158-1700 |
Second Address | Salt Lake City, UT 84132-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/05/2006 |
Last Update Date | 27/10/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F71036 | (02) |