Healthcare Provider Details

I. General information

NPI: 1861003220
Provider Name (Legal Business Name): SERGIO VINCENTE GODINEZ PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/11/2020
Last Update Date: 03/26/2026
Certification Date: 03/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

49869 CALHOUN ST
COACHELLA CA
92236-9720
US

IV. Provider business mailing address

49869 CALHOUN ST
COACHELLA CA
92236-9720
US

V. Phone/Fax

Practice location:
  • Phone: 760-399-4526
  • Fax: 858-634-6928
Mailing address:
  • Phone: 760-399-4526
  • Fax: 858-634-6928

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number58644
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: