Healthcare Provider Details

I. General information

NPI: 1992015945
Provider Name (Legal Business Name): SALVADORA ANN GODOROV DSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/08/2010
Last Update Date: 06/17/2022
Certification Date: 06/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1744 W HORIZON RIDGE PKWY
HENDERSON NV
89012-4833
US

IV. Provider business mailing address

290 SUTTON HILLS PL
HENDERSON NV
89002-9745
US

V. Phone/Fax

Practice location:
  • Phone: 702-742-3093
  • Fax: 702-933-9122
Mailing address:
  • Phone: 702-376-2838
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: