Healthcare Provider Details

I. General information

NPI: 1881105773
Provider Name (Legal Business Name): TERRY ALLEN WOOD RRT, RPSGT, BCB
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/18/2017
Last Update Date: 10/18/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24541 PACIFIC PARK DR
ALISO VIEJO CA
92656-3065
US

IV. Provider business mailing address

17601 WRIGHTWOOD LN
HUNTINGTON BEACH CA
92649-4953
US

V. Phone/Fax

Practice location:
  • Phone: 949-427-0999
  • Fax: 949-446-0585
Mailing address:
  • Phone: 714-486-7793
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License Number120052
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: