Provider Demographics
NPI:1669049391
Name:GODUGU, RASHMI (MD)
Entity type:Individual
Prefix:
First Name:RASHMI
Middle Name:
Last Name:GODUGU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1131 W 6TH ST STE 150
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91762-1116
Mailing Address - Country:US
Mailing Address - Phone:909-482-4462
Mailing Address - Fax:
Practice Address - Street 1:1131 W 6TH ST STE 150
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91762-1116
Practice Address - Country:US
Practice Address - Phone:909-482-4462
Practice Address - Fax:909-482-4485
Is Sole Proprietor?:No
Enumeration Date:2021-06-10
Last Update Date:2024-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA197625207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine