Healthcare Provider Details

I. General information

NPI: 1922747930
Provider Name (Legal Business Name): PETER JOSEPH GODOY III DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/31/2022
Last Update Date: 09/25/2025
Certification Date: 09/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5565 GROSSMONT CENTER DR STE 3 SUITE 510
LA MESA CA
91942-3007
US

IV. Provider business mailing address

5565 GROSSMONT CENTER DR STE 3 SUITE 510
LA MESA CA
91942-3007
US

V. Phone/Fax

Practice location:
  • Phone: 619-303-7130
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number5951001465
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License Number5951001465
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberE6178
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: