Provider Demographics
NPI:1467413765
Name:GODINEZ, ANISA M (MD)
Entity Type:Individual
Prefix:MRS
First Name:ANISA
Middle Name:M
Last Name:GODINEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 678342
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75267-8342
Mailing Address - Country:US
Mailing Address - Phone:512-244-4400
Mailing Address - Fax:512-244-4752
Practice Address - Street 1:1400 HESTERS CROSSING RD
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78681-8025
Practice Address - Country:US
Practice Address - Phone:512-244-4400
Practice Address - Fax:512-244-4752
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-28
Last Update Date:2014-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ4821208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX089777902Medicaid
TX089777902Medicaid
TX00L41DMedicare PIN
TX260024227Medicare PIN
TX8F0639Medicare PIN
TX8F20562Medicare PIN