Provider Demographics
NPI:1619529898
Name:GOODWIN, TATIANA VICTORIA
Entity Type:Individual
Prefix:
First Name:TATIANA
Middle Name:VICTORIA
Last Name:GOODWIN
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 1:298 BERNAL RD
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95119-1809
Mailing Address - Country:US
Mailing Address - Phone:408-404-8673
Mailing Address - Fax:
Practice Address - Street 1:298 BERNAL RD
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95119-1809
Practice Address - Country:US
Practice Address - Phone:408-404-8673
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-09
Last Update Date:2019-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist