Healthcare Provider Details

I. General information

NPI: 1124213608
Provider Name (Legal Business Name): LINDA WOODARD MD PEDIATRIC ALTERNATIVES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/07/2007
Last Update Date: 08/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 THOMAS DR
MILL VALLEY CA
94941-1615
US

IV. Provider business mailing address

10 THOMAS DR
MILL VALLEY CA
94941-1615
US

V. Phone/Fax

Practice location:
  • Phone: 415-380-8448
  • Fax: 415-380-8673
Mailing address:
  • Phone: 415-380-8448
  • Fax: 415-380-8673

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberG070541
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberG82105
License Number StateCA

VIII. Authorized Official

Name: MRS. JENAY JONES
Title or Position: OFFICE MANAGER
Credential:
Phone: 415-380-8448