Provider Demographics
NPI:1316792344
Name:GOUGH, ELIZABETH BRADLEY (CD)
Entity type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:BRADLEY
Last Name:GOUGH
Suffix:
Gender:F
Credentials:CD
Other - Prefix:
Other - First Name:BETSY
Other - Middle Name:
Other - Last Name:GOUGH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CD(DONA)
Mailing Address - Street 1:118 LAURENT
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-8302
Mailing Address - Country:US
Mailing Address - Phone:562-685-6803
Mailing Address - Fax:
Practice Address - Street 1:118 LAURENT
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-8302
Practice Address - Country:US
Practice Address - Phone:562-685-6803
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-22
Last Update Date:2024-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula