Provider Demographics
NPI:1316295249
Name:GODINEZ, DIANA IVETH (NP)
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:IVETH
Last Name:GODINEZ
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:620 N O CONNOR RD
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75061-7530
Mailing Address - Country:US
Mailing Address - Phone:972-259-3541
Mailing Address - Fax:972-225-4101
Practice Address - Street 1:620 N O CONNOR RD
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75061-7530
Practice Address - Country:US
Practice Address - Phone:972-259-3541
Practice Address - Fax:972-225-4101
Is Sole Proprietor?:No
Enumeration Date:2012-08-27
Last Update Date:2021-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12086111N00000X
TXAP136934363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No111N00000XChiropractic ProvidersChiropractor