Provider Demographics
NPI:1114263472
Name:GOLDSMITH, JACLYN JENNIFER (RD)
Entity Type:Individual
Prefix:MISS
First Name:JACLYN
Middle Name:JENNIFER
Last Name:GOLDSMITH
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4777 MEAD AVE
Mailing Address - Street 2:UNIT A
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95822-1273
Mailing Address - Country:US
Mailing Address - Phone:916-762-0089
Mailing Address - Fax:
Practice Address - Street 1:4777 MEAD AVE
Practice Address - Street 2:UNIT A
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95822-1273
Practice Address - Country:US
Practice Address - Phone:916-762-0089
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-13
Last Update Date:2012-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1089364133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered