Healthcare Provider Details

I. General information

NPI: 1992414593
Provider Name (Legal Business Name): MARGARITA S WOOD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: RITA WOOD

II. Dates (important events)

Enumeration Date: 11/22/2022
Last Update Date: 11/22/2022
Certification Date: 11/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5018 E SHASTA ST
PHOENIX AZ
85044-3321
US

IV. Provider business mailing address

5018 E SHASTA ST
PHOENIX AZ
85044-3321
US

V. Phone/Fax

Practice location:
  • Phone: 302-703-9106
  • Fax:
Mailing address:
  • Phone: 302-703-9106
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number StateOK
# 3
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: