Provider Demographics
NPI:1689690133
Name:GODREAU, EILEEN (MD)
Entity Type:Individual
Prefix:DR
First Name:EILEEN
Middle Name:
Last Name:GODREAU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:EILEEN
Other - Middle Name:MILAGROS
Other - Last Name:GODREAU
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:M D
Mailing Address - Street 1:1729 CALLE DONCELLA
Mailing Address - Street 2:URBANIZATION SAN ANTONIO
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00728-1623
Mailing Address - Country:US
Mailing Address - Phone:787-842-7508
Mailing Address - Fax:
Practice Address - Street 1:850 CALLE ARNALDO BRISTOL
Practice Address - Street 2:SUITE 1 EDIFICIO FISA
Practice Address - City:GUAYAMA
Practice Address - State:PR
Practice Address - Zip Code:00784-6876
Practice Address - Country:US
Practice Address - Phone:787-866-8775
Practice Address - Fax:787-866-8795
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR8927207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRF69539Medicare UPIN