Healthcare Provider Details

I. General information

NPI: 1326127580
Provider Name (Legal Business Name): IGNATIUS P GODOY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16660 PARAMOUNT BLVD SUITE 206
PARAMOUNT CA
90723-5458
US

IV. Provider business mailing address

16660 PARAMOUNT BLVD SUITE 206
PARAMOUNT CA
90723-5458
US

V. Phone/Fax

Practice location:
  • Phone: 562-634-9433
  • Fax: 562-634-6075
Mailing address:
  • Phone: 562-634-9433
  • Fax: 562-634-6075

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA048799
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: