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General NPI Number Information
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NPI Number | 1205236676
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Entity Type | Organization
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Legal Business Name | CARLOS D. GODINEZ, JR., M.D., PLLC
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Dates
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Enumeration Date | 09/03/2014
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Last Update Date | 09/03/2014
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Provider Practice Location Address
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Address Line | 414 NAVARRO ST STE 816
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City | SAN ANTONIO
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State | TX
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Zip | 78205-2518
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Country | US
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Telephone | 210-804-2020
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Fax |
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Provider Business Mailing Address
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Address Line | 414 NAVARRO ST STE 816
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City | SAN ANTONIO
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State | TX
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Zip | 78205-2518
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Country | US
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Telephone | 210-804-2020
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | CARLOS D. GODINEZ JR.
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Credential | M.D.
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Telephone | 210-804-2020
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number |
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License Number State | TX
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