Provider Demographics
NPI:1043445844
Name:GODES, MARIANNA (LAC)
Entity Type:Individual
Prefix:
First Name:MARIANNA
Middle Name:
Last Name:GODES
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8759 DALLAS ST
Mailing Address - Street 2:
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91942-3202
Mailing Address - Country:US
Mailing Address - Phone:858-337-9559
Mailing Address - Fax:
Practice Address - Street 1:4002 PARK BLVD STE E
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-2600
Practice Address - Country:US
Practice Address - Phone:858-337-9559
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-21
Last Update Date:2014-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC12945171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist