Healthcare Provider Details

I. General information

NPI: 1174715080
Provider Name (Legal Business Name): MEG WOODARD R.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/14/2007
Last Update Date: 09/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

445 MARINE VIEW AVE SUITE 300
DEL MAR CA
92014-3969
US

IV. Provider business mailing address

7521 BRAVA ST
CARLSBAD CA
92009-7504
US

V. Phone/Fax

Practice location:
  • Phone: 760-889-9643
  • Fax:
Mailing address:
  • Phone: 760-889-9643
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberPAF813657
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: