Provider Demographics
NPI:1851425243
Name:GOODMAN, STEVEN MARCUS (LAC)
Entity Type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:MARCUS
Last Name:GOODMAN
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:22691 LAMBERT ST
Mailing Address - Street 2:SUITE 512
Mailing Address - City:LAKE FOREST
Mailing Address - State:CA
Mailing Address - Zip Code:92630-1614
Mailing Address - Country:US
Mailing Address - Phone:949-460-9378
Mailing Address - Fax:949-460-9011
Practice Address - Street 1:22691 LAMBERT ST
Practice Address - Street 2:SUITE 512
Practice Address - City:LAKE FOREST
Practice Address - State:CA
Practice Address - Zip Code:92630-1614
Practice Address - Country:US
Practice Address - Phone:949-460-9378
Practice Address - Fax:949-460-9011
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 6181171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist