Provider Demographics
NPI:1295278190
Name:GOISET, JULIE
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:GOISET
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17701 AVALON BLVD
Mailing Address - Street 2:SPC 95
Mailing Address - City:CARSON
Mailing Address - State:CA
Mailing Address - Zip Code:90746-1554
Mailing Address - Country:US
Mailing Address - Phone:310-529-7557
Mailing Address - Fax:
Practice Address - Street 1:510 N PROSPECT AVE STE 208
Practice Address - Street 2:
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90277-3030
Practice Address - Country:US
Practice Address - Phone:310-529-7557
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-23
Last Update Date:2016-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA43152174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist