MEDICARE: DR. TERESA M. GODINEZ M.D.

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	207R00000X	Internal Medicine Physician	D0065910	MD
2	207R00000X	Internal Medicine Physician	105929	FL
3	207R00000X	Internal Medicine Physician	L1329	TX

General Provider Information

NPI Number	:	1922270982
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TERESA M. GODINEZ M.D.

Provider Business Mailing Address
First Line	:	22250 BULVERDE RD
Second Line	:	STE 120
City	:	SAN ANTONIO
State	:	TX
Zip	:	78261-3084
Country	:	US
Telephone Number	:	210-401-8185
Fax Number	:	210-401-8186

Provider Business Practice Location Address
First Line	:	22250 BULVERDE RD
Second Line	:	STE 120
City	:	SAN ANTONIO
State	:	TX
Zip	:	78261-3084
Country	:	US
Telephone Number	:	210-401-8185
Fax Number	:	210-401-8186

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

Provider Enumeration Date	:	03/31/2008
Last Update Date	:	01/16/2014

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