Healthcare Provider Details

I. General information

NPI: 1518877893
Provider Name (Legal Business Name): HECTOR MANUEL GODINEZ JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/09/2026
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1160 N DUTTON AVE STE 120
SANTA ROSA CA
95401-4652
US

IV. Provider business mailing address

1205 MYRTLE ST APT 7
CALISTOGA CA
94515-1753
US

V. Phone/Fax

Practice location:
  • Phone: 707-541-6258
  • Fax:
Mailing address:
  • Phone: 510-365-4286
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172M00000X
TaxonomyMechanotherapist
License Number94591
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: