Provider Demographics
NPI:1205291515
Name:FENUKU, GODWIN (MSW)
Entity type:Individual
Prefix:
First Name:GODWIN
Middle Name:
Last Name:FENUKU
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9990 COUNTY FARM RD
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92503-3542
Mailing Address - Country:US
Mailing Address - Phone:951-265-1219
Mailing Address - Fax:951-358-3548
Practice Address - Street 1:26542 LIDO DR
Practice Address - Street 2:
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92563-8001
Practice Address - Country:US
Practice Address - Phone:951-565-7551
Practice Address - Fax:951-358-3548
Is Sole Proprietor?:No
Enumeration Date:2015-12-31
Last Update Date:2024-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA493791041C0700X
CA94149101YM0800X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health