MEDICARE: ADRIAN AMADOR GODOY

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	106S00000X	Behavior Technician	RBT-18-70494	CA
2	101YA0400X	Addiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number	:	1801365960
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ADRIAN AMADOR GODOY

Provider Business Mailing Address
First Line	:	3462 PATRITTI AVE
Second Line	:
City	:	BALDWIN PARK
State	:	CA
Zip	:	91706-3509
Country	:	US
Telephone Number	:	626-434-6014
Fax Number	:

Provider Business Practice Location Address
First Line	:	525 CABRILLO PARK DR STE 140
Second Line	:
City	:	SANTA ANA
State	:	CA
Zip	:	92701-5012
Country	:	US
Telephone Number	:	626-434-6014
Fax Number	:

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

Provider Enumeration Date	:	11/19/2018
Last Update Date	:	09/28/2021

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Directions to “ ADRIAN AMADOR GODOY ” Practice Location

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