Provider Demographics
NPI:1942866488
Name:GODINEZ, JASMIN
Entity Type:Individual
Prefix:MS
First Name:JASMIN
Middle Name:
Last Name:GODINEZ
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 1:712 TENNYSON DR
Mailing Address - Street 2:
Mailing Address - City:GILROY
Mailing Address - State:CA
Mailing Address - Zip Code:95020-5536
Mailing Address - Country:US
Mailing Address - Phone:650-722-6745
Mailing Address - Fax:
Practice Address - Street 1:712 TENNYSON DR
Practice Address - Street 2:
Practice Address - City:GILROY
Practice Address - State:CA
Practice Address - Zip Code:95020-5536
Practice Address - Country:US
Practice Address - Phone:650-722-6745
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-09
Last Update Date:2019-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty