Healthcare Provider Details

I. General information

NPI: 1164797684
Provider Name (Legal Business Name): LUIS ARMANDO GODOY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/16/2012
Last Update Date: 08/12/2020
Certification Date: 08/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2335 STOCKTON BLVD. NAOB SUITE 6120
SACRAMENTO CA
95817-2200
US

IV. Provider business mailing address

2335 STOCKTON BLVD. NAOB SUITE 6120
SACRAMENTO CA
95817
US

V. Phone/Fax

Practice location:
  • Phone: 916-734-3861
  • Fax: 916-734-3006
Mailing address:
  • Phone: 916-734-3861
  • Fax: 916-734-3066

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberA140225
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License NumberA140225
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: