Healthcare Provider Details

I. General information

NPI: 1275829756
Provider Name (Legal Business Name): ANIKA GODHWANI DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2011
Last Update Date: 07/17/2023
Certification Date: 07/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

830 SCENIC DR
MODESTO CA
95350-6131
US

IV. Provider business mailing address

PO BOX 577197
MODESTO CA
95357-7197
US

V. Phone/Fax

Practice location:
  • Phone: 209-541-2470
  • Fax: 209-541-2996
Mailing address:
  • Phone: 510-209-3752
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20A12411
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: