Healthcare Provider Details

I. General information

NPI: 1275623191
Provider Name (Legal Business Name): NATHANIEL ROHDE WOODRUFF M.D., PHD, FACC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 02/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 CATHERINE LN STE F
GRASS VALLEY CA
95945-5719
US

IV. Provider business mailing address

3400 DATA DR ATTN: CREDENTIALING/PAYER ENROLLMENT
RANCHO CORDOVA CA
95670-7956
US

V. Phone/Fax

Practice location:
  • Phone: 530-477-8358
  • Fax: 530-477-2015
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberC55840
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: