Provider Demographics
NPI:1538706932
Name:GODINEZ, DUBIS IRENE
Entity type:Individual
Prefix:
First Name:DUBIS
Middle Name:IRENE
Last Name:GODINEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6160 CORNERSTONE CT E STE 100
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92121-3724
Mailing Address - Country:US
Mailing Address - Phone:858-216-8837
Mailing Address - Fax:619-941-0276
Practice Address - Street 1:6160 CORNERSTONE CT E STE 100
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121-3724
Practice Address - Country:US
Practice Address - Phone:858-216-8837
Practice Address - Fax:619-941-0276
Is Sole Proprietor?:No
Enumeration Date:2019-12-04
Last Update Date:2023-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARBT-17-45728106S00000X
CA1-22-59801103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician