Provider Demographics
NPI:1306455829
Name:GOO, CATHLYN
Entity type:Individual
Prefix:
First Name:CATHLYN
Middle Name:
Last Name:GOO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3221 W TEMPLE ST APT 203
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90026-7087
Mailing Address - Country:US
Mailing Address - Phone:808-271-7811
Mailing Address - Fax:
Practice Address - Street 1:305 N BREED ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90033-1801
Practice Address - Country:US
Practice Address - Phone:323-264-0347
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-30
Last Update Date:2020-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA82400183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist