Healthcare Provider Details

I. General information

NPI: 1548176340
Provider Name (Legal Business Name): ROBERT GODINA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/21/2026
Last Update Date: 08/21/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

47915 OASIS ST STE B
INDIO CA
92201-6950
US

IV. Provider business mailing address

25141 SILENT CREEK RD
MORENO VALLEY CA
92553-4337
US

V. Phone/Fax

Practice location:
  • Phone: 760-239-9187
  • Fax: 760-600-5037
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: