Provider Demographics
NPI:1841678737
Name:GOINS, KEVIN EARL
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:EARL
Last Name:GOINS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:503 OLYMPIC BLVD
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90401-3311
Mailing Address - Country:US
Mailing Address - Phone:310-450-4050
Mailing Address - Fax:310-450-7309
Practice Address - Street 1:503 OLYMPIC BLVD
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90401-3311
Practice Address - Country:US
Practice Address - Phone:310-450-4050
Practice Address - Fax:310-450-7309
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-11
Last Update Date:2017-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator