Provider Demographics
NPI:1982780847
Name:SUMALANGCAY, GODOFREDA (MD)
Entity type:Individual
Prefix:DR
First Name:GODOFREDA
Middle Name:
Last Name:SUMALANGCAY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 WESTERN AVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92411-1356
Mailing Address - Country:US
Mailing Address - Phone:909-880-3065
Mailing Address - Fax:909-473-0445
Practice Address - Street 1:1800 WESTERN AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92411-1356
Practice Address - Country:US
Practice Address - Phone:909-880-3065
Practice Address - Fax:909-473-0445
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-31
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA370350208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A370350Medicaid