Healthcare Provider Details

I. General information

NPI: 1043012834
Provider Name (Legal Business Name): NICHOLAS WOODS PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2025
Last Update Date: 01/06/2026
Certification Date: 01/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 S ELISEO DR STE 103
GREENBRAE CA
94904-2150
US

IV. Provider business mailing address

1000 S ELISEO DR STE 103
GREENBRAE CA
94904-2150
US

V. Phone/Fax

Practice location:
  • Phone: 415-461-9770
  • Fax:
Mailing address:
  • Phone: 415-461-9770
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA67367
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: