Healthcare Provider Details

I. General information

NPI: 1629879788
Provider Name (Legal Business Name): REBECCA GODIN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/24/2025
Last Update Date: 03/24/2025
Certification Date: 03/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9100 WILSHIRE BLVD STE 840W
BEVERLY HILLS CA
90212-3556
US

IV. Provider business mailing address

12121 W OLYMPIC BLVD APT 7125
LOS ANGELES CA
90064-1369
US

V. Phone/Fax

Practice location:
  • Phone: 424-777-0708
  • Fax:
Mailing address:
  • Phone: 650-888-0667
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95033573
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: