Provider Demographics
NPI:1063419083
Name:GOODSON, CHRISTINA DOLORES (RD,LDCDE)
Entity type:Individual
Prefix:MRS
First Name:CHRISTINA
Middle Name:DOLORES
Last Name:GOODSON
Suffix:
Gender:F
Credentials:RD,LDCDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 211699
Mailing Address - Street 2:
Mailing Address - City:EAGAN
Mailing Address - State:MN
Mailing Address - Zip Code:55121-3699
Mailing Address - Country:US
Mailing Address - Phone:866-849-0692
Mailing Address - Fax:
Practice Address - Street 1:20405 STATE HIGHWAY 249 STE 325
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77070-2893
Practice Address - Country:US
Practice Address - Phone:866-849-0692
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-05
Last Update Date:2024-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND10168133V00000X
OR10226392133V00000X
OHLD.09528133V00000X
TXDT05156133V00000X
IL164008823133V00000X
HI401-LD133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00385PMedicare UPIN