Healthcare Provider Details

I. General information

NPI: 1063452316
Provider Name (Legal Business Name): JOHN WOODCOCK DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2006
Last Update Date: 01/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39115 TRADE CENTER DR
PALMDALE CA
93551-3649
US

IV. Provider business mailing address

44469 10TH ST WEST
LANCASTER CA
93534
US

V. Phone/Fax

Practice location:
  • Phone: 661-273-0100
  • Fax: 661-273-5812
Mailing address:
  • Phone: 661-945-9411
  • Fax: 661-945-7115

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20A6801
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: