MEDICARE: GODANG NINA MAHARANI

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician	RBT-25-470746	CA

General Provider Information

NPI Number	:	1174489702
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GODANG NINA MAHARANI

Provider Business Mailing Address
First Line	:	6800 WYNDHAM DR APT 7
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95823-4920
Country	:	US
Telephone Number	:	916-410-3412
Fax Number	:

Provider Business Practice Location Address
First Line	:	6800 WYNDHAM DR APT 7
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95823-4920
Country	:	US
Telephone Number	:	916-410-3412
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/29/2025
Last Update Date	:	12/29/2025

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