Provider Demographics
NPI:1851676795
Name:GODINEZ MADRID, GENEVEVE
Entity Type:Individual
Prefix:
First Name:GENEVEVE
Middle Name:
Last Name:GODINEZ MADRID
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4219 ESTRELLA AVE UNIT A
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92115
Mailing Address - Country:US
Mailing Address - Phone:619-522-4690
Mailing Address - Fax:804-828-0489
Practice Address - Street 1:4701 VON KARMAN AVE STE. 331
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:CA
Practice Address - Zip Code:92660
Practice Address - Country:US
Practice Address - Phone:949-536-5133
Practice Address - Fax:323-301-4860
Is Sole Proprietor?:No
Enumeration Date:2011-10-11
Last Update Date:2021-07-29
Deactivation Date:2021-06-01
Deactivation Code:
Reactivation Date:2021-07-26
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No171M00000XOther Service ProvidersCase Manager/Care Coordinator