Provider Demographics
NPI:1780963777
Name:GODWIN, NEAL
Entity type:Individual
Prefix:
First Name:NEAL
Middle Name:
Last Name:GODWIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12624 MISTY PL
Mailing Address - Street 2:
Mailing Address - City:CERRITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90703-6070
Mailing Address - Country:US
Mailing Address - Phone:562-243-1977
Mailing Address - Fax:
Practice Address - Street 1:11500 BROOKSHIRE AVENUE
Practice Address - Street 2:
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90241
Practice Address - Country:US
Practice Address - Phone:562-904-5000
Practice Address - Fax:562-904-5140
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-09
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A13484207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine