Most Relevant Information
Provider Data
| NPI Number: | 1003441130 |
| Provider Name: | JENNIE IVON GODOY |
| Entity Type: | Individual |
| Taxonomy Code: | 126800000X |
| Specialty: | Dental Assistant |
| License Number: | RDA94371 |
Most Important Dates
| Enumeration Date: | 03/09/2020 |
| Last Updated: | 03/09/2020 |
Provider Practice Location
1646 FARNAM PL
POMONA
CA
917665331
Practice Location Phone/Fax
| Phone: | 9092428543 |
| Fax: |
Provider Mailing Location
763 RIO RANCHO RD STE 120
POMONA
CA
917667015
Provider Mailing Phone/Fax
| Phone: | 9097661922 |
| Fax: |