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General NPI Number Information
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NPI Number | 1215230164
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Entity Type | Individual
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Provider Name | TINA GODWIN WADIWALA D.O.
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Gender | Female
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Dates
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Enumeration Date | 12/15/2010
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Last Update Date | 05/23/2023
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Provider Practice Location Address
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Address Line | 107 S FAIR OAKS AVE STE 313
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City | PASADENA
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State | CA
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Zip | 91105-2084
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Country | US
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Telephone | 626-487-7766
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Fax |
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Provider Business Mailing Address
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Address Line | 107 S FAIR OAKS AVE STE 313
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City | PASADENA
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State | CA
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Zip | 91105-2084
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Country | US
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Telephone | 626-487-7766
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 20A11528
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License Number State | CA
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