Provider Demographics
NPI:1356721369
Name:GOODWIN, VICTORIA (MA, RD, LDN)
Entity type:Individual
Prefix:MRS
First Name:VICTORIA
Middle Name:
Last Name:GOODWIN
Suffix:
Gender:F
Credentials:MA, RD, LDN
Other - Prefix:
Other - First Name:VICTORIA
Other - Middle Name:
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, RD, LDN
Mailing Address - Street 1:12054 GLENFIELD RD
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19154-2815
Mailing Address - Country:US
Mailing Address - Phone:215-255-5452
Mailing Address - Fax:
Practice Address - Street 1:12054 GLENFIELD RD
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19154-2815
Practice Address - Country:US
Practice Address - Phone:215-255-5452
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-04
Last Update Date:2016-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA1053925133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered