Provider Demographics
NPI:1942950084
Name:ALVAREZ GODINEZ, JOSE MANUEL (HCA)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:MANUEL
Last Name:ALVAREZ GODINEZ
Suffix:
Gender:M
Credentials:HCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2424 N TUSTIN AVE APT F6
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705-1618
Mailing Address - Country:US
Mailing Address - Phone:714-747-1925
Mailing Address - Fax:
Practice Address - Street 1:2424 N TUSTIN AVE APT F6
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-1618
Practice Address - Country:US
Practice Address - Phone:714-747-1925
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-23
Last Update Date:2022-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA751-746-34143747A0650X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider