Provider Demographics
NPI:1790092104
Name:CYNTHIA M HOM-GOODMAN MD INC
Entity Type:Organization
Organization Name:CYNTHIA M HOM-GOODMAN MD INC
Other - Org Name:CYNTHIA M GOODMAN MD INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:GOODMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:415-925-8555
Mailing Address - Street 1:1240 S ELISEO DR
Mailing Address - Street 2:SUITE 201
Mailing Address - City:GREENBRAE
Mailing Address - State:CA
Mailing Address - Zip Code:94904-2028
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1240 S ELISEO DR
Practice Address - Street 2:SUITE 201
Practice Address - City:GREENBRAE
Practice Address - State:CA
Practice Address - Zip Code:94904-2028
Practice Address - Country:US
Practice Address - Phone:415-925-8555
Practice Address - Fax:415-925-4082
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-07
Last Update Date:2010-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA73359174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty