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Individual

JENNIE IVON GODOY

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
1646 FARNAM PL, POMONA, CA 91766-5331
(909) 242-8543
Mailing address
763 RIO RANCHO RD STE 120, POMONA, CA 91766-7015
(909) 766-1922

Taxonomy

Speciality
Code
Description
License number
State
126800000X
Dental Assistant
Primary
RDA94371
CA

Other

Enumeration date
03/09/2020
Last updated
03/09/2020
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