Provider Demographics
NPI:1609189224
Name:GODEBU, ELANA (MD)
Entity Type:Individual
Prefix:DR
First Name:ELANA
Middle Name:
Last Name:GODEBU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MISS
Other - First Name:ELANA
Other - Middle Name:
Other - Last Name:BIEDERMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:516 WEST ATEN ROAD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:IMPERIAL
Mailing Address - State:CA
Mailing Address - Zip Code:92251
Mailing Address - Country:US
Mailing Address - Phone:760-355-7730
Mailing Address - Fax:
Practice Address - Street 1:1665 SOUTH IMPERIAL AVENUE
Practice Address - Street 2:SUITE B
Practice Address - City:EL CENTRO
Practice Address - State:CA
Practice Address - Zip Code:92243
Practice Address - Country:US
Practice Address - Phone:442-231-8101
Practice Address - Fax:442-231-8616
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-24
Last Update Date:2023-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA119468208800000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program