Provider Demographics
NPI:1942328182
Name:NORWALK MATERNITY AND FAMILY MEDICAL CENTER INC.
Entity Type:Organization
Organization Name:NORWALK MATERNITY AND FAMILY MEDICAL CENTER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:IGNATIUS
Authorized Official - Middle Name:
Authorized Official - Last Name:GODOY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:562-406-8634
Mailing Address - Street 1:11741 THE PLZ
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:CA
Mailing Address - Zip Code:90650-3932
Mailing Address - Country:US
Mailing Address - Phone:562-406-8634
Mailing Address - Fax:562-406-8635
Practice Address - Street 1:11741 THE PLZ
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CA
Practice Address - Zip Code:90650-3932
Practice Address - Country:US
Practice Address - Phone:562-406-8634
Practice Address - Fax:562-406-8635
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101630207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0078000Medicaid