Provider Demographics
NPI:1073125670
Name:GODOY, ALISIA
Entity Type:Individual
Prefix:
First Name:ALISIA
Middle Name:
Last Name:GODOY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1321 W 36TH ST APT 2
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90007-3900
Mailing Address - Country:US
Mailing Address - Phone:951-293-6008
Mailing Address - Fax:
Practice Address - Street 1:225 S LAKE AVE STE 300
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91101-3009
Practice Address - Country:US
Practice Address - Phone:323-244-8300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-17
Last Update Date:2020-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician