Healthcare Provider Details

I. General information

NPI: 1184931263
Provider Name (Legal Business Name): PHYLLIS DAISY WOO M.P.H.,W.H.N.P-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2010
Last Update Date: 05/01/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1530 HILLHURST AVE
LOS ANGELES CA
90027-5516
US

IV. Provider business mailing address

4216 FOUNTAIN AVE
LOS ANGELES CA
90029-2256
US

V. Phone/Fax

Practice location:
  • Phone: 323-644-3888
  • Fax:
Mailing address:
  • Phone: 323-644-3888
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberF420993-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: