Provider Demographics
NPI:1124128533
Name:GODZIK, CATHLEEN ANN (MEDICAL DOCTOR)
Entity type:Individual
Prefix:
First Name:CATHLEEN
Middle Name:ANN
Last Name:GODZIK
Suffix:
Gender:F
Credentials:MEDICAL DOCTOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1245 WILSHIRE BLVD
Mailing Address - Street 2:SUITE 611
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90017-4810
Mailing Address - Country:US
Mailing Address - Phone:213-482-6100
Mailing Address - Fax:213-482-6104
Practice Address - Street 1:1245 WILSHIRE BLVD
Practice Address - Street 2:SUITE 611
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90017-4810
Practice Address - Country:US
Practice Address - Phone:213-482-6100
Practice Address - Fax:213-482-6104
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2008-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA657775207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
G57775Medicare ID - Type Unspecified
A93492Medicare UPIN