Provider Demographics
NPI:1265211981
Name:GOODWIN, MORGAN (LAC)
Entity type:Individual
Prefix:
First Name:MORGAN
Middle Name:
Last Name:GOODWIN
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12500 RIVERSIDE DR STE 202
Mailing Address - Street 2:
Mailing Address - City:VALLEY VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91607-3441
Mailing Address - Country:US
Mailing Address - Phone:213-700-1085
Mailing Address - Fax:
Practice Address - Street 1:12500 RIVERSIDE DR STE 202
Practice Address - Street 2:
Practice Address - City:VALLEY VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91607-3441
Practice Address - Country:US
Practice Address - Phone:213-700-1085
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-22
Last Update Date:2023-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19638171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist