Healthcare Provider Details

I. General information

NPI: 1073791398
Provider Name (Legal Business Name): HECTOR GODINA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2008
Last Update Date: 12/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10155 COLIMA RD
WHITTIER CA
90603-2042
US

IV. Provider business mailing address

711 S NEW HAMPSHIRE AVE
LOS ANGELES CA
90005-1831
US

V. Phone/Fax

Practice location:
  • Phone: 562-692-0383
  • Fax:
Mailing address:
  • Phone: 213-385-5100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: