Healthcare Provider Details

I. General information

NPI: 1972506632
Provider Name (Legal Business Name): PAUL JEFFREY GODIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/24/2005
Last Update Date: 04/18/2023
Certification Date: 04/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1595 SOQUEL DR STE 230
SANTA CRUZ CA
95065-1721
US

IV. Provider business mailing address

3400 DATA DR
RANCHO CORDOVA CA
95670-7956
US

V. Phone/Fax

Practice location:
  • Phone: 831-226-3225
  • Fax: 831-423-7579
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberG71662
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: