SHANNON M. GODDARD (NPI# 1780961417) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1780961417 |
Entity Type | Individual |
Full Name | SHANNON M. GODDARD |
Credential | PA |
Practice Address |
7592 Broadway Lemon Grove CA 91945-1604 |
Mailing Address |
Po Box 158 Espanola NM 87532-0158 |
Practice Telephone | 6195152300 |
Mailing Telephone | 5057537218 |
Mailing Fax Number | 5057477396 |
Enumeration Date | 2011-11-09 |
Last Update Date | 2020-03-25 |
Gender Code | F |
Is Sole Proprietor | N |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
N | 363A00000X | Physician Assistant | 3347 | CO | Physician Assistants & Advanced Practice Nursing Providers |
Y | 363AM0700X |
Physician Assistant Specialization: Medical |
56072 | CA | Physician Assistants & Advanced Practice Nursing Providers |
Street Address |
7592 BROADWAY |
City | LEMON GROVE |
State | CA |
Zip Code | 91945-1604 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1053369439 | Elizabeth A Samuels | Nurse Practitioner | 7592 Broadway, Lemon Grove Family Health Center, Lemon Grove, CA 91945 | 2006-05-05 |
1316471519 | Amanda L. Marriage | Psychologist | 7592 Broadway, Lemon Grove, CA 91945-1604 | 2017-04-13 |
1578993788 | Jessica Rose Toth | Nurse Practitioner | 7592 Broadway, Lemon Grove, CA 91945-1604 | 2013-11-25 |
1427282466 | Family Health Centers of San Diego, Inc | Clinic/Center | 7592 Broadway, Lemon Grove, CA 91945-1604 | 2009-05-05 |
1184886186 | Gilberto Cota | Family Medicine | 7592 Broadway, Lemon Grove, CA 91945 | 2008-06-30 |
1093976748 | Joseph Nadim Sleiman | Pediatrics | 7592 Broadway, Lemon Grove, CA 91945-1604 | 2008-06-24 |
1629289400 | Yuhee Kim | Family Medicine | 7592 Broadway, Lemon Grove, CA 91945 | 2007-05-24 |
1932329505 | David Eaton Fleming | Physician Assistant | 7592 Broadway, Lemon Grove, CA 91945-1604 | 2007-04-26 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1093347759 | Myisha Michelle Holloway-griffin | Counselor | 2409 Skyline Dr, Lemon Grove, CA 91945 | 2020-02-10 |
1831737626 | Jennifer Murillo | Counselor | 2049 Skyline Dr. Lemon Grove Ca, 91945, Lemon Grove, CA 91945 | 2019-12-12 |
1487193140 | Golden State Nem Transportation.llc | Non-emergency Medical Transport (VAN) | 7107 Broadway Unit 158, Lemon Grove, CALIFORNIA 91945 | 2017-02-14 |
1700323581 | Juuni Transportation | Non-emergency Medical Transport (VAN) | 7138 Westview Pl #a, Lemon Grove, CA 91945 | 2017-01-31 |
1568815249 | Danyelle Goldstein | Substance Abuse Rehabilitation Facility | 2049 Sklyline Dr, Lemon Grove, CA 91945 | 2016-07-19 |
1942550397 | Debora L Stolz | Case Manager/Care Coordinator | 3434 Lemon Grove St, Lemon Grove, CA 91945 | 2012-09-13 |
1336449321 | Leslie Ann Warner | Counselor | 7526 Mt. Vernon St, Lemon Grove, CA 91945 | 2010-10-25 |
1013235126 | Mcalister Institute | Case Management | 2049 Skyline Drive, Lemon Grove, CA 91945 | 2010-05-13 |
1639389554 | Jarbou & Jarbou, Inc | Secured Medical Transport (VAN) | 6975 North Ave, Lemon Grove, CA 91945 | 2007-05-22 |
1275656555 | Amy L Stewart | Physical Therapist | 4171 Las Palmas Square, San Diego, CA 91945 | 2007-04-09 |
Find all providers in zip 91945 |
Taxonomy Code | 363AM0700X |
Grouping | Physician Assistants & Advanced Practice Nursing Providers |
Classification | Physician Assistant |
Specialization | Medical |
Definition to come... |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1306132121 | Elizabeth Mae Hollo | Physician Assistant | 7967 Broadway, Lemon Grove, CA 91945-1809 | 2011-06-20 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1760089437 | Karine Harutyunyan | Physician Assistant | 500 E Colorado St Ste 101, Glendale, CA 91205-1607 | 2020-10-06 |
1437756228 | Kale Burket | Physician Assistant | Bldg 523, S 8th St, El Centro, CA 92243 | 2020-10-05 |
1548867666 | Heba Marzouk Al-shoubaki | Physician Assistant | 633 S Pepper St, Anaheim, CA 92802-1459 | 2020-10-01 |
1275140550 | Lisa Lynn Passalacqua | Physician Assistant | 431 7th St, Norco, CA 92860-1671 | 2020-09-30 |
1144833989 | Trisha Taylor | Physician Assistant | 10399 Tivoli Way, Yucaipa, CA 92399-6017 | 2020-08-30 |
1457963944 | Harlan William Monahan | Physician Assistant | 5210 Del Rio Rd, Sacramento, CA 95822-2519 | 2020-08-18 |
1275144313 | Sofia Carmen Bustillo | Physician Assistant | 1709 Coral Pl, Seal Beach, CA 90740-5712 | 2020-08-12 |
1124638663 | Gayaneh Gharakhani | Physician Assistant | 1323 E Broadway Apt 110, Glendale, CA 91205-4018 | 2020-08-07 |
1144830183 | Loc Bao Tran | Physician Assistant | 8937 Emerson Pl, Rosemead, CA 91770-2813 | 2020-08-04 |
1558997957 | Sarah Lubinsky | Physician Assistant | 1511 Montana Ave, Santa Monica, CA 90403-1891 | 2020-03-17 |
Find all providers with the same taxonomy |
City | LEMON GROVE |
Zip Code | 91945 |
Please comment or provide details below to improve the information on SHANNON M. GODDARD.
Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.