MEDICARE: MRS. BRENDA MARIE WOODS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1639315351
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. BRENDA MARIE WOODS

Provider Business Mailing Address
First Line	:	11234 VALLEY BLVD
Second Line	:
City	:	EL MONTE
State	:	CA
Zip	:	91731-3241
Country	:	US
Telephone Number	:	626-575-4001
Fax Number	:	626-579-7214

Provider Business Practice Location Address
First Line	:	11234 VALLEY BLVD
Second Line	:
City	:	EL MONTE
State	:	CA
Zip	:	91731-3241
Country	:	US
Telephone Number	:	626-575-4001
Fax Number	:	626-579-7214

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/30/2008
Last Update Date	:	12/30/2008

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