Healthcare Provider Details

I. General information

NPI: 1972789188
Provider Name (Legal Business Name): IGNATIUS P. GODOY, M.D., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2008
Last Update Date: 12/30/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16660 PARAMOUNT BLVD STE. 206
PARAMOUNT CA
90723-5433
US

IV. Provider business mailing address

16660 PARAMOUNT BLVD STE. 206
PARAMOUNT CA
90723-5433
US

V. Phone/Fax

Practice location:
  • Phone: 562-634-0449
  • Fax: 562-634-6075
Mailing address:
  • Phone: 424-242-1464
  • 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: MISS HOPE CARDENAS
Title or Position: MEDICAL BILLER
Credential: CPC
Phone: 562-634-0449