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General NPI Number Information
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NPI Number | 1083843882
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Entity Type | Organization
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Legal Business Name | GODOFREDO ASTUDILLO MD INC
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Dates
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Enumeration Date | 07/14/2009
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Last Update Date | 07/14/2009
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Provider Practice Location Address
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Address Line | 2032 MARENGO ST SUITE 143
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City | LOS ANGELES
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State | CA
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Zip | 90033-1319
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Country | US
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Telephone | 323-255-9500
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Fax | 323-965-7754
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Provider Business Mailing Address
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Address Line | 2032 MARENGO ST SUITE 143
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City | LOS ANGELES
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State | CA
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Zip | 90033-1319
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Country | US
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Telephone | 323-255-9500
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Fax | 323-965-7754
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. GODOFREDO L ASTUDILLO
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Credential | M.D.
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Telephone | 323-225-9500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | A26755
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License Number State | CA
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