Healthcare Provider Details

I. General information

NPI: 1053101436
Provider Name (Legal Business Name): BRANDON CRUZ GODINA MS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/09/2025
Last Update Date: 05/09/2025
Certification Date: 05/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 S MILLS RD
VENTURA CA
93003-3434
US

IV. Provider business mailing address

100 S MILLS RD
VENTURA CA
93003-3487
US

V. Phone/Fax

Practice location:
  • Phone: 805-289-7900
  • Fax:
Mailing address:
  • Phone: 805-289-7900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: