Individual
MR. KIM DALE GOODRUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
R.N.
Contact information
Practice address
825 PALMILLA DR, MODESTO, CA 95356-1152
(209) 572-3243
Mailing address
825 PALMILLA DR, MODESTO, CA 95356-1152
(209) 572-3243
Taxonomy
Speciality
Code
Description
License number
State
163WP0808X
Psychiatric/Mental Health Registered Nurse
Primary
696742
CA
Other
Enumeration date
06/08/2008
Last updated
06/08/2008
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