Provider Demographics
NPI:1760653885
Name:VENERACION-GODOY, CAROL (PA-C)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:
Last Name:VENERACION-GODOY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8706 IMPERIAL HWY
Mailing Address - Street 2:
Mailing Address - City:DOWNEY
Mailing Address - State:CA
Mailing Address - Zip Code:90242-3906
Mailing Address - Country:US
Mailing Address - Phone:562-923-8300
Mailing Address - Fax:562-923-8334
Practice Address - Street 1:8706 IMPERIAL HWY
Practice Address - Street 2:
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90242-3906
Practice Address - Country:US
Practice Address - Phone:562-923-8300
Practice Address - Fax:562-923-8334
Is Sole Proprietor?:No
Enumeration Date:2008-03-17
Last Update Date:2011-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA19520363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant