Provider Demographics
NPI:1699022418
Name:GOODSTEIN, LISA (LAC)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:GOODSTEIN
Suffix:
Gender:F
Credentials:LAC
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 7262
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:CA
Mailing Address - Zip Code:95604-7262
Mailing Address - Country:US
Mailing Address - Phone:530-305-0431
Mailing Address - Fax:530-820-3147
Practice Address - Street 1:134 ALMOND ST
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:CA
Practice Address - Zip Code:95603-5240
Practice Address - Country:US
Practice Address - Phone:530-305-0431
Practice Address - Fax:530-820-3147
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-10
Last Update Date:2015-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14596171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist