Healthcare Provider Details

I. General information

NPI: 1093154825
Provider Name (Legal Business Name): STEVEN GODELMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2013
Last Update Date: 03/27/2025
Certification Date: 03/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4500 BROCKTON AVE
RIVERSIDE CA
92501-4090
US

IV. Provider business mailing address

22 EBB TIDE CIR
NEWPORT BEACH CA
92663-2842
US

V. Phone/Fax

Practice location:
  • Phone: 951-788-3000
  • Fax:
Mailing address:
  • Phone: 818-606-5495
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMT204735
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code2086S0127X
TaxonomyTrauma Surgery Physician
License NumberME152582
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code2086S0127X
TaxonomyTrauma Surgery Physician
License Number163683
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: