Provider Demographics
NPI:1942539200
Name:GOLDIZEN, JEANETTE ALICE (CLD,CCCE,CLEC)
Entity Type:Individual
Prefix:MRS
First Name:JEANETTE
Middle Name:ALICE
Last Name:GOLDIZEN
Suffix:
Gender:F
Credentials:CLD,CCCE,CLEC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3050 WEST AVENUR L-6
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93536-4044
Mailing Address - Country:US
Mailing Address - Phone:661-492-6259
Mailing Address - Fax:
Practice Address - Street 1:3050 W AVENUE L6
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93536-4044
Practice Address - Country:US
Practice Address - Phone:661-492-6259
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-16
Last Update Date:2009-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula