Provider Demographics
NPI:1083859300
Name:GOLDSTEIN, CATHY L (AP)
Entity Type:Individual
Prefix:
First Name:CATHY
Middle Name:L
Last Name:GOLDSTEIN
Suffix:
Gender:F
Credentials:AP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11512 LAKE MEAD AVE
Mailing Address - Street 2:# 605
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-9680
Mailing Address - Country:US
Mailing Address - Phone:904-900-1477
Mailing Address - Fax:904-551-1265
Practice Address - Street 1:11512 LAKE MEAD AVE
Practice Address - Street 2:# 605
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-9680
Practice Address - Country:US
Practice Address - Phone:904-900-1477
Practice Address - Fax:904-551-1265
Is Sole Proprietor?:No
Enumeration Date:2008-12-16
Last Update Date:2015-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP2384171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist