Provider Demographics
NPI:1467332791
Name:GOOLSBY, ASHTEN (LAC, DACM)
Entity type:Individual
Prefix:
First Name:ASHTEN
Middle Name:
Last Name:GOOLSBY
Suffix:
Gender:F
Credentials:LAC, DACM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7506 ALONDA WAY
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92126-1013
Mailing Address - Country:US
Mailing Address - Phone:360-977-0629
Mailing Address - Fax:
Practice Address - Street 1:9474 KEARNY VILLA RD STE 113
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92126-4596
Practice Address - Country:US
Practice Address - Phone:360-977-0629
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-05
Last Update Date:2025-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20440171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist