Provider Demographics
NPI:1093477846
Name:GODOY, EDGARDO
Entity Type:Individual
Prefix:
First Name:EDGARDO
Middle Name:
Last Name:GODOY
Suffix:
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 1:121 CALLE CRUZ ORTIZ STELLA S
Mailing Address - Street 2:
Mailing Address - City:HUMACAO
Mailing Address - State:PR
Mailing Address - Zip Code:00791-3727
Mailing Address - Country:US
Mailing Address - Phone:939-439-5988
Mailing Address - Fax:
Practice Address - Street 1:121 CALLE CRUZ ORTIZ STELLA S
Practice Address - Street 2:
Practice Address - City:HUMACAO
Practice Address - State:PR
Practice Address - Zip Code:00791-3727
Practice Address - Country:US
Practice Address - Phone:939-439-5988
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-08
Last Update Date:2021-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR76492163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse