Provider Demographics
NPI:1770012155
Name:GODOY, PEDRO DANIEL SR
Entity Type:Individual
Prefix:
First Name:PEDRO
Middle Name:DANIEL
Last Name:GODOY
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9422 HINDI ST
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78224-2702
Mailing Address - Country:US
Mailing Address - Phone:210-941-5984
Mailing Address - Fax:210-568-2953
Practice Address - Street 1:9422 HINDI ST.
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78224
Practice Address - Country:US
Practice Address - Phone:210-941-5984
Practice Address - Fax:210-568-2953
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant