Provider Demographics
NPI:1235771882
Name:GOLETA, HAILLEY
Entity Type:Individual
Prefix:
First Name:HAILLEY
Middle Name:
Last Name:GOLETA
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 1:1401 EBONY DR
Mailing Address - Street 2:
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93030-8797
Mailing Address - Country:US
Mailing Address - Phone:805-657-1264
Mailing Address - Fax:
Practice Address - Street 1:957 FAULKNER RD STE 105
Practice Address - Street 2:
Practice Address - City:SANTA PAULA
Practice Address - State:CA
Practice Address - Zip Code:93060-9129
Practice Address - Country:US
Practice Address - Phone:805-765-4773
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-16
Last Update Date:2019-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT297379225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist