Provider Demographics
NPI:1962099242
Name:GODINEZ, GILBERT JR
Entity type:Individual
Prefix:
First Name:GILBERT
Middle Name:
Last Name:GODINEZ
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11046 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:EL MONTE
Mailing Address - State:CA
Mailing Address - Zip Code:91731-2617
Mailing Address - Country:US
Mailing Address - Phone:626-444-9000
Mailing Address - Fax:626-444-9044
Practice Address - Street 1:2436 WABASH AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90033-2510
Practice Address - Country:US
Practice Address - Phone:323-780-8756
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-21
Last Update Date:2020-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)