Provider Demographics
NPI:1043882020
Name:GOTOC, JODY ANNE MARIE ALLANIGUE
Entity Type:Individual
Prefix:
First Name:JODY
Middle Name:ANNE MARIE ALLANIGUE
Last Name:GOTOC
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1808 NORTHWESTERN CIR
Mailing Address - Street 2:
Mailing Address - City:COLTON
Mailing Address - State:CA
Mailing Address - Zip Code:92324-6222
Mailing Address - Country:US
Mailing Address - Phone:909-263-7437
Mailing Address - Fax:
Practice Address - Street 1:1808 NORTHWESTERN CIR
Practice Address - Street 2:
Practice Address - City:COLTON
Practice Address - State:CA
Practice Address - Zip Code:92324-6222
Practice Address - Country:US
Practice Address - Phone:909-263-7437
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-11
Last Update Date:2021-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA83483183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist