Provider Demographics
NPI:1841422599
Name:GODZICH, MICAELA CAROLINE (MD)
Entity Type:Individual
Prefix:DR
First Name:MICAELA
Middle Name:CAROLINE
Last Name:GODZICH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4860 Y STREET, SUITE 1600
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95817
Mailing Address - Country:US
Mailing Address - Phone:916-734-3630
Mailing Address - Fax:916-734-5636
Practice Address - Street 1:4860 Y STREET, SUITE 1600
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95817
Practice Address - Country:US
Practice Address - Phone:916-734-3630
Practice Address - Fax:916-734-5636
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-13
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD605039852207Q00000X
CAA109054207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8932970, G8932971Medicare PIN