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General NPI Number Information
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NPI Number | 1609189224
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Entity Type | Individual
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Provider Name | ELANA GODEBU M.D.
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Gender | Female
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Dates
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Enumeration Date | 07/24/2010
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Last Update Date | 12/19/2024
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Provider Practice Location Address
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Address Line | 1600 SOUTH IMPERIAL AVENUE SUITE 4
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City | EL CENTRO
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State | CA
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Zip | 92243
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Country | US
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Telephone | 442-325-9959
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Fax | 760-355-9523
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Provider Business Mailing Address
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Address Line | 516 WEST ATEN ROAD SUITE 2
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City | IMPERIAL
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State | CA
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Zip | 92251-9805
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Country | US
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Telephone | 760-355-7730
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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 | 208800000X
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Taxonomy Name | Urology Physician
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License Number | A119468
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License Number State | CA
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