Look up the most recent NPI and PECOS records

Jerry M Goffman

Psychologist

Behavioral Health & Social Service Providers

8253 White Oak Ave, Rancho Cucamonga, CA 91730-7671

PECOS Enrollment

Based on the most recent information from CMS, provider Jerry M Goffman does not have current enrollment records in PECOS.

Part B
Medicare Part B
Not Enrolled
HHA
Home Health Agency
Not Enrolled
DME
Durable Medical Equipment
Not Enrolled
PMD
Power Mobility Device
Not Enrolled

CMS last updated its PECOS records 3 days ago.

Profile Details

Provider ID
1124137765
Provider Type
Individual
Full Name
Goffman, Jerry M
Title
Dr.
Credential
PHD.

Gender
Male
Sole Proprietor
Yes
Enumeration Date
8/29/2006
Last Updated
10/1/2007

Contact Information

Practice Location

8253 White Oak Ave, Rancho Cucamonga, CA 91730-7671

(951) 312-1041

Unlisted Fax

Mailing Location

1040 S Mount Vernon Ave, G-306, Colton, CA 92324-4228

(951) 312-1041

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 103T00000X Primary	Description Psychologist Behavioral Health & Social Service Providers	License PSY7081 California

Provider Identifiers

ID	Description	Issuer
ID PSY070812	Description Medicaid	Issuer Unlisted California
ID PSY070811	Description Medicaid	Issuer Unlisted California

Jerry M Goffman

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

Provider Identifiers

ID

Description

Issuer

ID

Description

Issuer

ID

Description

Issuer

Swan, June Angela

Lupien, Christopher J

Gunn, Timothy

Lupien, Charyeea Na'Chelle

Adhami, Sepideh

Soriano, Marcel

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Dey, Brittany Wanland

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Chacon, Vallerie