Provider Demographics
NPI:1922270982
Name:GODINEZ, TERESA M (MD)
Entity Type:Individual
Prefix:DR
First Name:TERESA
Middle Name:M
Last Name:GODINEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:22250 BULVERDE RD
Mailing Address - Street 2:STE 120
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78261-3084
Mailing Address - Country:US
Mailing Address - Phone:210-401-8185
Mailing Address - Fax:210-401-8186
Practice Address - Street 1:22250 BULVERDE RD
Practice Address - Street 2:STE 120
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78261-3084
Practice Address - Country:US
Practice Address - Phone:210-401-8185
Practice Address - Fax:210-401-8186
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-31
Last Update Date:2014-01-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD0065910207R00000X
FL105929207R00000X
TXL1329207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine