Healthcare Provider Details

I. General information

NPI: 1225609928
Provider Name (Legal Business Name): JOHN PADILLA GODOY RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/05/2021
Last Update Date: 07/05/2021
Certification Date: 07/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2776 PACIFIC AVE
LONG BEACH CA
90806-2613
US

IV. Provider business mailing address

1840 CATLIN ST
FULLERTON CA
92833-5647
US

V. Phone/Fax

Practice location:
  • Phone: 562-997-2000
  • Fax: 562-997-2515
Mailing address:
  • Phone: 714-515-9975
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number539413
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: