Healthcare Provider Details

I. General information

NPI: 1609189224
Provider Name (Legal Business Name): ELANA GODEBU M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MISS ELANA BIEDERMAN

II. Dates (important events)

Enumeration Date: 07/24/2010
Last Update Date: 12/19/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 SOUTH IMPERIAL AVENUE SUITE 4
EL CENTRO CA
92243
US

IV. Provider business mailing address

516 WEST ATEN ROAD SUITE 2
IMPERIAL CA
92251-9805
US

V. Phone/Fax

Practice location:
  • Phone: 442-325-9959
  • Fax: 760-355-9523
Mailing address:
  • Phone: 760-355-7730
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberA119468
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: