Provider Demographics
NPI:1205384799
Name:GOSLICKA, ANNA BEATA
Entity Type:Individual
Prefix:MRS
First Name:ANNA
Middle Name:BEATA
Last Name:GOSLICKA
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 1:427 14TH ST
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90402-2131
Mailing Address - Country:US
Mailing Address - Phone:310-592-5951
Mailing Address - Fax:
Practice Address - Street 1:427 14TH ST
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90402-2131
Practice Address - Country:US
Practice Address - Phone:310-592-5951
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-14
Last Update Date:2016-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA123620174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist