Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife | 444 | CA |
N | 176B00000X | Midwife | 99235 | TX |
NPI | 1174075576 |
---|---|
Provider Name | Marea Goodman |
First Address | Oakland, CA 94611-1331 |
Second Address | Oakland, CA 94611-1331 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/11/2016 |
Last Update Date | 01/11/2016 |