Provider Demographics
NPI:1487082442
Name:GOODMAN, RACHEL (MS, RD)
Entity type:Individual
Prefix:MRS
First Name:RACHEL
Middle Name:
Last Name:GOODMAN
Suffix:
Gender:F
Credentials:MS, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18372 CLARK ST
Mailing Address - Street 2:SUITE 228
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91356-3508
Mailing Address - Country:US
Mailing Address - Phone:818-881-9192
Mailing Address - Fax:
Practice Address - Street 1:18372 CLARK ST
Practice Address - Street 2:SUITE 228
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-3508
Practice Address - Country:US
Practice Address - Phone:818-881-9192
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-29
Last Update Date:2013-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1088452133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered