Provider Demographics
NPI:1861016958
Name:GODES, JONATHAN (PHLEBOTOMY TECH)
Entity Type:Individual
Prefix:MR
First Name:JONATHAN
Middle Name:
Last Name:GODES
Suffix:
Gender:M
Credentials:PHLEBOTOMY TECH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:878 COMPASS WAY
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92154-5839
Mailing Address - Country:US
Mailing Address - Phone:619-359-7551
Mailing Address - Fax:
Practice Address - Street 1:878 COMPASS WAY
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92154-5839
Practice Address - Country:US
Practice Address - Phone:619-359-7551
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-03
Last Update Date:2020-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA01004500246RP1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomyGroup - Single Specialty