Provider Demographics
NPI:1225589427
Name:RECHKUNOVA-GOODSON, MARIA ALEXANDROVNA (ND)
Entity Type:Individual
Prefix:DR
First Name:MARIA
Middle Name:ALEXANDROVNA
Last Name:RECHKUNOVA-GOODSON
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:MASHA
Other - Middle Name:ALEXANDROVNA
Other - Last Name:RECHKUNOVA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:ND
Mailing Address - Street 1:17172 BOLSA CHICA ST
Mailing Address - Street 2:APT 49
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92649-4478
Mailing Address - Country:US
Mailing Address - Phone:714-924-5592
Mailing Address - Fax:
Practice Address - Street 1:316 REDONDO AVE
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90814-2651
Practice Address - Country:US
Practice Address - Phone:714-924-5592
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-23
Last Update Date:2016-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAND826175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath