Provider Demographics
NPI:1235472804
Name:GOFF, ADRIANNE (CCN, MH)
Entity Type:Individual
Prefix:
First Name:ADRIANNE
Middle Name:
Last Name:GOFF
Suffix:
Gender:F
Credentials:CCN, MH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:980 LINCOLN AVE STE 200B
Mailing Address - Street 2:
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94901-8802
Mailing Address - Country:US
Mailing Address - Phone:415-846-4515
Mailing Address - Fax:415-456-4124
Practice Address - Street 1:980 LINCOLN AVE STE 200B
Practice Address - Street 2:
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94901-8802
Practice Address - Country:US
Practice Address - Phone:415-846-4515
Practice Address - Fax:415-456-4124
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-02
Last Update Date:2013-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist