Active NPI
Lisa Goodman, PA
- Physician Assistant
- Los Angeles, CA
National Provider Identifier
1134449564
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 20043
- Practice address
- 11760 San Vicente Blvd
Los Angeles, CA 90049-5010 - Phone
- (310) 400-6534
- NPI assigned
- Jun 8, 2010
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 20043 | CA | Primary |
Addresses
Primary practice location
11760 San Vicente Blvd
Los Angeles, CA 90049-5010
Mailing address
11760 San Vicente Blvd
Los Angeles, CA 90049-5010
Phone (310) 424-8238
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 20043 | CA | MD | Speech-Language Pathologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Fountain Resources, Inc. | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Nutritionist
- Beverly Hills, CA
- NPI 1104151273
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1275955200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1670457600000",
"number": "1134449564",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11760 SAN VICENTE BLVD",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900495010",
"telephone_number": "310-424-8238"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11760 SAN VICENTE BLVD",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900495010",
"telephone_number": "310-400-6534"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GOODMAN",
"first_name": "LISA",
"credential": "PA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2010-06-08",
"last_updated": "2022-12-08",
"certification_date": "2022-12-08",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "CA",
"license": "20043",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Los Angeles, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 8, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.