MEDICARE: DR. PAUL JEFFREY GODIN MD

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	174400000X	Specialist	G71662	CA

General Provider Information

NPI Number	:	1972506632
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PAUL JEFFREY GODIN MD

Provider Business Mailing Address
First Line	:	3400 DATA DR
Second Line	:
City	:	RANCHO CORDOVA
State	:	CA
Zip	:	95670-7956
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1595 SOQUEL DR STE 230
Second Line	:
City	:	SANTA CRUZ
State	:	CA
Zip	:	95065-1721
Country	:	US
Telephone Number	:	831-226-3225
Fax Number	:	831-423-7579

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

Provider Enumeration Date	:	05/24/2005
Last Update Date	:	04/18/2023

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