Healthcare Provider Details

I. General information

NPI: 1730573395
Provider Name (Legal Business Name): APOLLONIA GODOY NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: APOLLONIA MENDOZA NP

II. Dates (important events)

Enumeration Date: 03/22/2015
Last Update Date: 10/19/2021
Certification Date: 10/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1670 E. 120TH ST 4TH FLOOR, MODULE A
LOS ANGELES CA
90059
US

IV. Provider business mailing address

222 N. TOLUCA ST APT 3.
LOS ANGELES CA
90026
US

V. Phone/Fax

Practice location:
  • Phone: 424-338-1000
  • Fax: 310-223-0192
Mailing address:
  • Phone: 213-864-0616
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number95004949
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95004949
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number688579
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: