MEDICARE: MARIO GODINEZ CADCII, CDVC, CAMS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	C25171214	CA

General Provider Information

NPI Number	:	1588199541
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIO GODINEZ CADCII, CDVC, CAMS

Provider Business Mailing Address
First Line	:	10953 RAMONA BLVD
Second Line	:
City	:	EL MONTE
State	:	CA
Zip	:	91731-2629
Country	:	US
Telephone Number	:	626-434-2723
Fax Number	:	626-279-2532

Provider Business Practice Location Address
First Line	:	10953 RAMONA BLVD
Second Line	:
City	:	EL MONTE
State	:	CA
Zip	:	91731-1319
Country	:	US
Telephone Number	:	626-434-2723
Fax Number	:	626-279-2532

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/27/2017
Last Update Date	:	04/26/2024

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