Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 50576 | KY |
N | 208000000X | Pediatrician | A156495 | CA |
Y | 2080P0207X | Pediatric Hematology-Oncologist | A156495 | CA |
NPI | 1184041634 |
---|---|
Provider Name | Dr. Megan Marie Gooch |
First Address | Orange, CA 92868-4203 |
Second Address | Orange, CA 92868-4203 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/03/2014 |
Last Update Date | 08/09/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
7100484820 | (05) | KY |
K120930 | MEDICARE (01) | KY |