Provider Demographics
NPI:1447799002
Name:GOOD, DAKODA
Entity type:Individual
Prefix:
First Name:DAKODA
Middle Name:
Last Name:GOOD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1399 S WINCHESTER BLVD
Mailing Address - Street 2:140
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95128-4300
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1399 S WINCHESTER BLVD
Practice Address - Street 2:140
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128-4300
Practice Address - Country:US
Practice Address - Phone:408-261-0772
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-15
Last Update Date:2017-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist