Provider Demographics
NPI:1205236676
Name:CARLOS D. GODINEZ, JR., M.D., PLLC
Entity type:Organization
Organization Name:CARLOS D. GODINEZ, JR., M.D., PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:D
Authorized Official - Last Name:GODINEZ
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:210-804-2020
Mailing Address - Street 1:414 NAVARRO ST STE 816
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78205-2518
Mailing Address - Country:US
Mailing Address - Phone:210-804-2020
Mailing Address - Fax:
Practice Address - Street 1:414 NAVARRO ST STE 816
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78205-2518
Practice Address - Country:US
Practice Address - Phone:210-804-2020
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-03
Last Update Date:2014-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty