Basic Information
| Provider Information | |||||||||
| NPI: | 1336218759 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GOETZ DE GAONA | ||||||||
| FirstName: | MARILYN | ||||||||
| MiddleName: | J | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1900 STATE ST | ||||||||
| Address2: | SUITE G | ||||||||
| City: | SANTA BARBARA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 931012429 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8056177858 | ||||||||
| FaxNumber: | 8058982002 | ||||||||
| Practice Location | |||||||||
| Address1: | 1900 STATE ST | ||||||||
| Address2: | SUITE G | ||||||||
| City: | SANTA BARBARA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 931012429 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8056177858 | ||||||||
| FaxNumber: | 8058982002 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/07/2006 | ||||||||
| LastUpdateDate: | 12/08/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LW0102X | NP1415 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Women's Health |
ID Information
| ID | Type | State | Issuer | Description | MG1215450 | 01 | CA | DEA NUMBER | OTHER | NP1415 | 01 | CA | NURSE PRACTITIONER LICENS | OTHER |