Healthcare Provider Details

I. General information

NPI: 1679941256
Provider Name (Legal Business Name): DAVID GODOT PSY.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2015
Last Update Date: 06/25/2020
Certification Date: 06/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3950 LONG BEACH BLVD STE 101
LONG BEACH CA
90807-5410
US

IV. Provider business mailing address

3950 LONG BEACH BLVD STE 101
LONG BEACH CA
90807-5410
US

V. Phone/Fax

Practice location:
  • Phone: 562-684-1300
  • Fax: 562-684-1301
Mailing address:
  • Phone: 562-684-1305
  • Fax: 562-684-1301

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY27572
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: