Provider Demographics
NPI:1528584166
Name:GOETZ, KRISTEN (CMT)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:
Last Name:GOETZ
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:309 N MOUNTAIN VIEW PL APT 9
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92831-4168
Mailing Address - Country:US
Mailing Address - Phone:805-305-5138
Mailing Address - Fax:
Practice Address - Street 1:309 N MOUNTAIN VIEW PL APT 9
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92831-4168
Practice Address - Country:US
Practice Address - Phone:805-305-5138
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-16
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program