Provider Demographics
NPI:1346961992
Name:GODINEZ MOJICA, NELIDA NOEMI
Entity Type:Individual
Prefix:
First Name:NELIDA
Middle Name:NOEMI
Last Name:GODINEZ MOJICA
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 1:1213 S 10TH AVE
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98902-5434
Mailing Address - Country:US
Mailing Address - Phone:509-952-0464
Mailing Address - Fax:
Practice Address - Street 1:1213 S 10TH AVE
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98902-5434
Practice Address - Country:US
Practice Address - Phone:509-952-0464
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-12
Last Update Date:2022-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA11217171R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171R00000XOther Service ProvidersInterpreter