Provider Demographics
NPI:1821376146
Name:GOODIN, SOQUEL L (NP-C)
Entity Type:Individual
Prefix:MISS
First Name:SOQUEL
Middle Name:L
Last Name:GOODIN
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:SOQUEL
Other - Middle Name:L
Other - Last Name:JACKSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:2050 S BLOSSER RD
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93458-7310
Mailing Address - Country:US
Mailing Address - Phone:805-361-8023
Mailing Address - Fax:805-361-8097
Practice Address - Street 1:416 SPRING ST
Practice Address - Street 2:A
Practice Address - City:PASO ROBLES
Practice Address - State:CA
Practice Address - Zip Code:93446-3161
Practice Address - Country:US
Practice Address - Phone:805-238-7250
Practice Address - Fax:805-238-0165
Is Sole Proprietor?:No
Enumeration Date:2011-08-03
Last Update Date:2016-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21069363LF0000X
CANP21096363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily