Provider Demographics
NPI:1912123597
Name:GOYAL, DEEPIKA (NP)
Entity Type:Individual
Prefix:MRS
First Name:DEEPIKA
Middle Name:
Last Name:GOYAL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MRS
Other - First Name:DEEPIKA
Other - Middle Name:
Other - Last Name:WYCOFF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1691 THE ALAMEDA
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95126-2203
Mailing Address - Country:US
Mailing Address - Phone:408-287-7532
Mailing Address - Fax:408-287-0405
Practice Address - Street 1:5440 THORNWOOD DR
Practice Address - Street 2:SUITE G
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95123-1217
Practice Address - Country:US
Practice Address - Phone:408-281-9777
Practice Address - Fax:408-281-3678
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2007-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP13729363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily