Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207YX0007X | Plastic Surgeon (Head & Neck) | G44674 | CA |
Y | 208D00000X | General Practice Physician | G44674 | CA |
NPI | 1881742674 |
---|---|
Provider Name | Lynn J. Goodloe |
First Address | West Hills, CA 91307-4032 |
Second Address | West Hills, CA 91307-4032 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/01/2007 |
Last Update Date | 16/06/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G446740 | (05) | CA |
B73024 | (02) |