Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QS0010X | Family Doctor - Sports Medicine | A71660 | CA |
N | 207V00000X | Obstetrician & Gynecologist | A71660 | CA |
NPI | 1184685141 |
---|---|
Provider Name | Mrs. Glenda Darlene Goodwin |
First Address | El Dorado Hills, CA 95762-9360 |
Second Address | El Dorado Hills, CA 95762-9360 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/03/2006 |
Last Update Date | 19/04/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00A716600 | (05) | CA |
H30996 | (02) |