Healthcare Provider Details

I. General information

NPI: 1609328905
Provider Name (Legal Business Name): WOODS MEDICAL AND ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2016
Last Update Date: 08/17/2023
Certification Date: 08/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4262 LYND AVE
ARCADIA CA
91006-5834
US

IV. Provider business mailing address

4262 LYND AVE
ARCADIA CA
91006-5834
US

V. Phone/Fax

Practice location:
  • Phone: 916-747-5155
  • Fax: 626-899-4440
Mailing address:
  • Phone: 916-747-5155
  • Fax: 626-899-4440

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCANP 21303
License Number StateCA

VIII. Authorized Official

Name: TEJON WOODS
Title or Position: NURSE PRACTITIONER
Credential: NP
Phone: 916-747-5155