Provider Demographics
NPI:1164663753
Name:GOODLY, MAY PRADEL (DNP, NP-C, CNS, BRN)
Entity Type:Individual
Prefix:DR
First Name:MAY
Middle Name:PRADEL
Last Name:GOODLY
Suffix:
Gender:F
Credentials:DNP, NP-C, CNS, BRN
Other - Prefix:DR
Other - First Name:MAY
Other - Middle Name:
Other - Last Name:PRADEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DNP
Mailing Address - Street 1:PO BOX 6400
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90504-0400
Mailing Address - Country:US
Mailing Address - Phone:310-214-5723
Mailing Address - Fax:
Practice Address - Street 1:3565 DEL AMO BLVD
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90503-1637
Practice Address - Country:US
Practice Address - Phone:310-214-5723
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-12
Last Update Date:2016-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18455363LG0600X
CA3034364SG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No364SG0600XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistGerontology