Provider Demographics
NPI:1982190716
Name:GOADE, GRACIA MARGARET (MD)
Entity Type:Individual
Prefix:
First Name:GRACIA
Middle Name:MARGARET
Last Name:GOADE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16891 CALLE DE SARAH
Mailing Address - Street 2:
Mailing Address - City:PACIFIC PALISADES
Mailing Address - State:CA
Mailing Address - Zip Code:90272-1952
Mailing Address - Country:US
Mailing Address - Phone:310-795-4662
Mailing Address - Fax:
Practice Address - Street 1:16891 CALLE DE SARAH
Practice Address - Street 2:
Practice Address - City:PACIFIC PALISADES
Practice Address - State:CA
Practice Address - Zip Code:90272-1952
Practice Address - Country:US
Practice Address - Phone:310-795-4662
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-04
Last Update Date:2018-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG40760208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery