Provider Demographics
NPI:1790756054
Name:GOINES, SANDRA LYNN (DO)
Entity Type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:LYNN
Last Name:GOINES
Suffix:
Gender:F
Credentials:DO
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Mailing Address - Street 1:5242 KATELLA AVE
Mailing Address - Street 2:SUITE 106
Mailing Address - City:LOS ALAMITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90720-2863
Mailing Address - Country:US
Mailing Address - Phone:562-431-5010
Mailing Address - Fax:562-431-7278
Practice Address - Street 1:5242 KATELLA AVE
Practice Address - Street 2:SUITE 106
Practice Address - City:LOS ALAMITOS
Practice Address - State:CA
Practice Address - Zip Code:90720-2863
Practice Address - Country:US
Practice Address - Phone:562-431-5010
Practice Address - Fax:562-431-7278
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-26
Last Update Date:2011-01-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CA2OA8212207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA8481336Medicaid
CAI12841Medicare UPIN
CA8481336Medicaid