Provider Demographics
NPI:1700044369
Name:GOULD-GOODMAN, RUTH (LAC)
Entity Type:Individual
Prefix:MRS
First Name:RUTH
Middle Name:
Last Name:GOULD-GOODMAN
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 1:1372 APPLETON WAY
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:CA
Mailing Address - Zip Code:90291-2917
Mailing Address - Country:US
Mailing Address - Phone:310-989-7884
Mailing Address - Fax:310-393-0588
Practice Address - Street 1:1372 APPLETON WAY
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:CA
Practice Address - Zip Code:90291-2917
Practice Address - Country:US
Practice Address - Phone:310-989-7884
Practice Address - Fax:310-393-0588
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-29
Last Update Date:2008-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACP2718171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist