Provider Demographics
NPI:1528045317
Name:GODBOLD SANCHEZ, MONIQUE T (MD)
Entity Type:Individual
Prefix:DR
First Name:MONIQUE
Middle Name:T
Last Name:GODBOLD SANCHEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MONIQUE
Other - Middle Name:T
Other - Last Name:SANCHEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:737 W CHILDS AVE
Mailing Address - Street 2:
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95341-6805
Mailing Address - Country:US
Mailing Address - Phone:209-383-1848
Mailing Address - Fax:209-383-1296
Practice Address - Street 1:797 W CHILDS AVE
Practice Address - Street 2:
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95341
Practice Address - Country:US
Practice Address - Phone:209-383-5811
Practice Address - Fax:209-383-1402
Is Sole Proprietor?:No
Enumeration Date:2005-12-22
Last Update Date:2018-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA74248207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A742480Medicaid
CA00A742480Medicare PIN
CAH71989Medicare UPIN