Healthcare Provider Details

I. General information

NPI: 1306438320
Provider Name (Legal Business Name): YADIRA GODINEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/10/2021
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24535 ATWOOD AVE
MORENO VALLEY CA
92553-3739
US

IV. Provider business mailing address

24535 ATWOOD AVE
MORENO VALLEY CA
92553-3739
US

V. Phone/Fax

Practice location:
  • Phone: 951-378-5859
  • Fax:
Mailing address:
  • Phone: 951-378-5859
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number37475
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: