Provider Demographics
NPI:1235647728
Name:GOODMAN, CAROLYN DAWN (NP-C)
Entity type:Individual
Prefix:
First Name:CAROLYN
Middle Name:DAWN
Last Name:GOODMAN
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:CAROLYN
Other - Middle Name:DAWN
Other - Last Name:TRIVETTE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4140 W 190TH ST
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90504-5513
Mailing Address - Country:US
Mailing Address - Phone:310-582-7900
Mailing Address - Fax:310-582-7996
Practice Address - Street 1:11800 WILSHIRE BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-6602
Practice Address - Country:US
Practice Address - Phone:310-582-7900
Practice Address - Fax:310-582-7996
Is Sole Proprietor?:No
Enumeration Date:2018-01-18
Last Update Date:2025-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANPF95008234363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily