Healthcare Provider Details

I. General information

NPI: 1124793823
Provider Name (Legal Business Name): TESSA THAO VI WOODS AUD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2021
Last Update Date: 03/30/2026
Certification Date: 03/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 W PROVIDENCE AVE
ORANGE CA
92868-3808
US

IV. Provider business mailing address

1201 W LA VETA AVE
ORANGE CA
92868-4203
US

V. Phone/Fax

Practice location:
  • Phone: 714-639-4990
  • Fax: 714-744-3841
Mailing address:
  • Phone: 714-509-7964
  • Fax: 714-509-4798

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberAU3998
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: