Provider Demographics
NPI:1013090398
Name:GOODMAN, KATHRYN DEENA (ARNP)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:DEENA
Last Name:GOODMAN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1912 TOPAZ AVE
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93004-3157
Mailing Address - Country:US
Mailing Address - Phone:954-536-7422
Mailing Address - Fax:805-323-5644
Practice Address - Street 1:6801 COLDWATER CANYON AVE
Practice Address - Street 2:VALLEY COMMUNITY CLINIC
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91605
Practice Address - Country:US
Practice Address - Phone:818-301-6320
Practice Address - Fax:818-766-8352
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2012-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN # 312998364SW0102X
CANP# 1691364SW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SW0102XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistWomen's Health