Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207L00000X | Anesthesiologist | MD020270E | PA |
N | 208000000X | Pediatrician | MD020270E | PA |
N | 2080P0203X | Pediatric Critical Care Doctor | MD020270E | PA |
NPI | 1205940772 |
---|---|
Provider Name | Dr. Rodolfo I Godinez |
First Address | Bryn Mawr, PA 19010-2028 |
Second Address | Bryn Mawr, PA 19010-2028 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/08/2006 |
Last Update Date | 26/08/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0006843530 | (05) | PA |
B95835 | (02) |