Provider Demographics
NPI:1285201616
Name:GOODS, KAITLIN NICOLE (PA-C)
Entity type:Individual
Prefix:
First Name:KAITLIN
Middle Name:NICOLE
Last Name:GOODS
Suffix:
Gender:
Credentials:PA-C
Other - Prefix:
Other - First Name:KAITLIN
Other - Middle Name:NICOLE
Other - Last Name:WOODS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4140 W 190TH ST
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90504-5513
Mailing Address - Country:US
Mailing Address - Phone:310-423-5874
Mailing Address - Fax:310-423-0139
Practice Address - Street 1:8635 W 3RD ST STE 675
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-6109
Practice Address - Country:US
Practice Address - Phone:310-423-5874
Practice Address - Fax:310-423-0139
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-04
Last Update Date:2025-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9114482207XX0801X, 363A00000X
CAPA10002363A00000X
CAPA65818363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No207XX0801XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Trauma