Healthcare Provider Details

I. General information

NPI: 1003850447
Provider Name (Legal Business Name): CRAIG ALAN WOOD P.A-C
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/16/2006
Last Update Date: 05/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18300 HIGHWAY 18
APPLE VALLEY CA
92307
US

IV. Provider business mailing address

2100 POWELL ST STE 900
EMERYVILLE CA
94608-1844
US

V. Phone/Fax

Practice location:
  • Phone: 760-242-2311
  • Fax:
Mailing address:
  • Phone: 510-350-2600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA16631
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: