Provider Demographics
NPI:1003896366
Name:GODES, IRINA (MD)
Entity Type:Individual
Prefix:DR
First Name:IRINA
Middle Name:
Last Name:GODES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:801 S CHEVY CHASE DR
Mailing Address - Street 2:20
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91205-4431
Mailing Address - Country:US
Mailing Address - Phone:818-265-2237
Mailing Address - Fax:818-265-2228
Practice Address - Street 1:12157 VICTORY BLVD
Practice Address - Street 2:
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91606-3204
Practice Address - Country:US
Practice Address - Phone:818-755-8000
Practice Address - Fax:818-755-8006
Is Sole Proprietor?:No
Enumeration Date:2006-01-20
Last Update Date:2009-01-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA72287208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH95664Medicare UPIN