1073379251 NPI number — MRS. SHERYL ALLENE GOULARTE MSN, PMHNP-BC

Table of content: PAUL DRENTH (NPI 1164973277)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073379251 NPI number — MRS. SHERYL ALLENE GOULARTE MSN, PMHNP-BC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GOULARTE
Provider First Name:
SHERYL
Provider Middle Name:
ALLENE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MSN, PMHNP-BC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1073379251
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/05/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
501 SAN BENITO ST STE 201
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOLLISTER
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95023-3903
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
831-801-6361
Provider Business Mailing Address Fax Number:
831-297-7110

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
18232 SMOKE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JAMESTOWN
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95327-9218
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
209-984-4820
Provider Business Practice Location Address Fax Number:
209-984-9240
Provider Enumeration Date:
02/26/2024

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LP0808X , with the licence number:  95030148 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363L00000X , with the licence number: 95030148 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





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