Provider Demographics
NPI:1639149966
Name:GODINEZ, FERMIN STEVEN (DO)
Entity Type:Individual
Prefix:
First Name:FERMIN
Middle Name:STEVEN
Last Name:GODINEZ
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 S 336TH ST
Mailing Address - Street 2:SUITE 600
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98003-6328
Mailing Address - Country:US
Mailing Address - Phone:253-838-6180
Mailing Address - Fax:253-838-6418
Practice Address - Street 1:801 E WHEELER RD
Practice Address - Street 2:
Practice Address - City:MOSES LAKE
Practice Address - State:WA
Practice Address - Zip Code:98837-1820
Practice Address - Country:US
Practice Address - Phone:509-766-1301
Practice Address - Fax:509-766-1306
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-26
Last Update Date:2008-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A7130207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA3075GOOtherBSWA
WA218368OtherLIWA
WA4688GOOtherBSWA
WA8468183Medicaid
WA0218178OtherLIWA
WA0218178OtherLIWA
WA218368OtherLIWA
WA4688GOOtherBSWA
WAP00370080Medicare PIN