Provider Demographics
NPI:1629200118
Name:GOINS, BERTHA COZZETTEA (RN, MS, IBCLC)
Entity Type:Individual
Prefix:MRS
First Name:BERTHA
Middle Name:COZZETTEA
Last Name:GOINS
Suffix:
Gender:F
Credentials:RN, MS, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 211236
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91921-1236
Mailing Address - Country:US
Mailing Address - Phone:619-318-7490
Mailing Address - Fax:
Practice Address - Street 1:531 LOS ANGELES PL
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92114-5323
Practice Address - Country:US
Practice Address - Phone:619-318-7490
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-17
Last Update Date:2009-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10521784IBCLC163W00000X
CA548713163WG0000X, 163WH0200X, 163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant
No163W00000XNursing Service ProvidersRegistered Nurse
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
No163WH0200XNursing Service ProvidersRegistered NurseHome Health