Provider Demographics
NPI:1821096942
Name:GOSKOWICZ, MAKI C
Entity Type:Individual
Prefix:DR
First Name:MAKI
Middle Name:C
Last Name:GOSKOWICZ
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:MAKI
Other - Middle Name:CHRISTINE
Other - Last Name:OKAMURA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8860 CENTER DR
Mailing Address - Street 2:STE 300
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91942-3068
Mailing Address - Country:US
Mailing Address - Phone:619-462-1670
Mailing Address - Fax:619-462-3209
Practice Address - Street 1:8860 CENTER DR
Practice Address - Street 2:STE 300
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942-3068
Practice Address - Country:US
Practice Address - Phone:619-462-1670
Practice Address - Fax:619-462-3209
Is Sole Proprietor?:No
Enumeration Date:2005-07-12
Last Update Date:2022-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG73340207ND0101X, 207NS0135X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G733400Medicaid
F81983Medicare UPIN
CA00G733400Medicaid