Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | A72287 | CA |
NPI | 1003896366 |
---|---|
Provider Name | Dr. Irina Godes |
First Address | Glendale, CA 91205-4431 |
Second Address | North Hollywood, CA 91606-3204 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/01/2006 |
Last Update Date | 20/01/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H95664 | (02) | CA |