Provider Demographics
NPI:1235207697
Name:GOOSSEN, AHNNA RHODES (LAC)
Entity Type:Individual
Prefix:
First Name:AHNNA
Middle Name:RHODES
Last Name:GOOSSEN
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1766 ESPERANZA CT
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95062-2958
Mailing Address - Country:US
Mailing Address - Phone:831-566-6461
Mailing Address - Fax:
Practice Address - Street 1:1245 1ST ST
Practice Address - Street 2:
Practice Address - City:GILROY
Practice Address - State:CA
Practice Address - Zip Code:95020-4733
Practice Address - Country:US
Practice Address - Phone:408-842-9688
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 8011171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist