Provider Demographics
NPI:1124785704
Name:GODINEZ, VANESSA ISABEL
Entity type:Individual
Prefix:
First Name:VANESSA
Middle Name:ISABEL
Last Name:GODINEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15630 ROSALES ST
Mailing Address - Street 2:
Mailing Address - City:SYLMAR
Mailing Address - State:CA
Mailing Address - Zip Code:91342-3646
Mailing Address - Country:US
Mailing Address - Phone:818-926-9932
Mailing Address - Fax:
Practice Address - Street 1:7335 VAN NUYS BLVD STE 118
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91405-1951
Practice Address - Country:US
Practice Address - Phone:310-282-8352
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-18
Last Update Date:2021-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA5613224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant