Healthcare Provider Details

I. General information

NPI: 1538706932
Provider Name (Legal Business Name): DUBIS IRENE GODINEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2019
Last Update Date: 05/09/2023
Certification Date: 05/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6160 CORNERSTONE CT E STE 100
SAN DIEGO CA
92121-3724
US

IV. Provider business mailing address

6160 CORNERSTONE CT E STE 100
SAN DIEGO CA
92121-3724
US

V. Phone/Fax

Practice location:
  • Phone: 858-216-8837
  • Fax: 619-941-0276
Mailing address:
  • Phone: 858-216-8837
  • Fax: 619-941-0276

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-22-59801
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-17-45728
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: