Individual
DR. JERRY M GOFFMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PHD.
Contact information
Practice address
8253 WHITE OAK AVE, RANCHO CUCAMONGA, CA 91730-7671
(951) 312-1041
Mailing address
1040 S MOUNT VERNON AVE, G-306, COLTON, CA 92324-4228
(951) 312-1041
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
PSY7081
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
PSY070811
—
CA
05
—
PSY070812
—
CA
Enumeration date
08/29/2006
Last updated
10/01/2007
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