Individual
RAUL GODINA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
512 N 21ST AVE, CALDWELL, ID 83605-4368
(208) 809-2875
(208) 809-2876
Mailing address
PO BOX 191050, BOISE, ID 83719-1050
(208) 955-6522
(208) 955-6503
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA-1250
ID
363AM0700X
Medical Physician Assistant
5210
AZ
Other
Enumeration date
09/12/2012
Last updated
07/30/2020
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