Provider Demographics
NPI:1124173216
Name:GOODRIDGE, BETH (RD)
Entity type:Individual
Prefix:
First Name:BETH
Middle Name:
Last Name:GOODRIDGE
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:612 SYCAMORE AVE
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95354-0151
Mailing Address - Country:US
Mailing Address - Phone:650-954-7946
Mailing Address - Fax:
Practice Address - Street 1:931 10TH ST STE 771
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95354-2305
Practice Address - Country:US
Practice Address - Phone:209-771-4717
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA913425133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered