SHANNON M. GODDARD


Address: 7592 Broadway, Lemon Grove, CA 91945-1604
Phone: 6195152300

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).

Provider Overview

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

Taxonomy

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

Office Location

Street Address 7592 BROADWAY
City LEMON GROVE
State CA
Zip Code 91945-1604

Providers in the same location

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

Providers in the same zip code

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
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Taxonomy Information

Taxonomy Code 363AM0700X
Grouping Physician Assistants & Advanced Practice Nursing Providers
Classification Physician Assistant
Specialization Medical

Taxonomy Definition

Definition to come...

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
1306132121 Elizabeth Mae Hollo Physician Assistant 7967 Broadway, Lemon Grove, CA 91945-1809 2011-06-20

Providers in the same taxonomy and state

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
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Competitor

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City LEMON GROVE
Zip Code 91945

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Dataset Information

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.

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