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General NPI Number Information
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NPI Number | 1770633547
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Entity Type | Organization
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Legal Business Name | MC GODOY, INC.
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Dates
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Enumeration Date | 01/12/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 415 E DRYDEN ST UNIT 101
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City | GLENDALE
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State | CA
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Zip | 91207-2229
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Country | US
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Telephone | 818-281-5906
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Fax | 818-241-5213
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Provider Business Mailing Address
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Address Line | 415 E DRYDEN ST APT 101 UNIT 101
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City | GLENDALE
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State | CA
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Zip | 91207-2251
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Country | US
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Telephone | 818-281-5906
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Fax | 818-241-5213
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Authorized Official
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Title or Position | PRESIDENT
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Name | MARIA CECILIA GODOY
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Credential |
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Telephone | 818-281-5906
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 27482
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License Number State | CA
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